Active Health & Welfare – Archived Plan Documents & Notices
This page contains information that is no longer current but remains on this site for reference purposes.
Plan Documents & Amendments
Plan A SPD – 2012
Plan B SPD – 2012
Plan C SPD – 2012
Enrollment
2020 Plan A Enrollment Guide
2020 Plan B Enrollment Guide
2020 Plan C Enrollment Guide
2020 Plan K20 Enrollment Guide
2020 Plan K500 Enrollment Guide
2020 Plan K1000 Enrollment Guide
2019 Plan A Enrollment Guide
2019 Plan B Enrollment Guide
2019 Plan C Enrollment Guide
2018 Plan K20 Enrollment Guide
2018 Plan K500 Enrollment Guide
2018 Plan K1000 Enrollment Guide
2017 Plan A Enrollment Guide
2017 Plan B Enrollment Guide
2017 Plan C Enrollment Guide
2017 Plan K20 Enrollment Guide
2017 Plan K500 Enrollment Guide
2017 Plan K1000 Enrollment Guide
Summary of Material Modifications & Plan Notices
December 2020 – Health Dynamics Program Exam Requirement Suspended for Plan Year 2021
December 2020 Plan Clarification for COVID-19 Emergency Period
December 2020 Plan Clarification of Coverage for Gene Therapy
Effective June 1, 2020 – Improvements in the MAC for Hip & Knee Surgery, June 2020 Eligibility for Class 1 Participants Only
Effective March 18, 2020 – Plan Changes for COVID-19
Effective January 1, 2020 – Health Dynamics Program Exam Requirement Suspended for Plan Year 2020
Effective September 1, 2019 – Bright Now! (Newport) Dental Plan Option is Terminated
Effective April 1, 2019 Initial Dental Enrollment & Enrolling a Newborn Child
Effective January 1, 2019 – Health Dynamics Program and Deductible Changes, Plans A,B, or C including COBRA Participants
Effective January 1, 2019 – Network Change for Participants Enrolled in Plan B Indemnity Plan
CalPERS & Anthem Blue Cross Hip and Knee Joint Replacement Program
Effective January 1, 2018 – Deductible Change, Plans A, B or C including COBRA Participants
Effective September 1, 2017 – Domestic Partner Coverage – Imputed Income
Effective July 1, 2015 – LiveHealth Online Services for Direct Pay Plan Participants
LiveHealth Online Brochure
Effective January 1, 2015, Direct Pay Plans – Out of Pocket Limits on Cost Sharing, New Blue Cross Value Based Program, Dollar Limit on Non-PPO Surgical Centers, & Specialty Medications
Health Dynamics Wellness Program Exam Requirement Suspended for Plan Year 2020
2020 Wellness Program – Exam Certification Form
Effective September 1, 2019 – Bright Now! (Newport) Dental Plan Option Termination
Effective September 1, 2016 – VSP Benefit Changes
Effective March 1, 2016 – New Hearing Aid Benefit Program thru HearUSA
HearUSA Brochure
Notice of Creditable Coverage
2020 Notice of Creditable Coverage
2019 Notice of Creditable Coverage
2018 Notice of Creditable Coverage
2017 Notice of Creditable Coverage
2016 Notice of Creditable Coverage
2015 Notice of Creditable Coverage
2014 Notice of Creditable Coverage
2011 Notice of Creditable Coverage
2010 Notice of Creditable Coverage
2009 Notice of Creditable Coverage
2008 Notice of Creditable Coverage
2007 Notice of Creditable Coverage
2005 Notice of Creditable Coverage