Retiree Health & Welfare Plan – Plan Documents & Forms
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Plan Documents & Amendments
Enrollment
2023 Retiree Enrollment Guide
CMTA-IAM Retiree Health & Welfare Plan Enrollment Form
Kaiser of Washington – Enrollment & Change Form
Kaiser of Washington – Medicare Advantage Election Form
Kaiser Senior Advantage – Group Election Request Form
Kaiser Medicare Participants – Hearing Aid & Dental Election Form
UnitedHealthCare – HMO Enrollment Form
General Forms
Summary of Material Modifications & Plan Notices
Effective January 1, 2019 – Advance Notice of Retiree Contribution Rates
Effective January 1, 2019 – Advance Notice of Retiree Subsidy Amount
2018 Notice of Creditable Coverage
Effective January 1, 2018 – Advance Notice of Retiree Contribution Rates
Effective January 1, 2018 – Advance Notice of Retiree Subsidy Amount
Effective January 1, 2017 – Medicare Retirees Medical Coverage
Effective January 1, 2019 – Advance Notice of Retiree Subsidy Amount
2018 Notice of Creditable Coverage
Effective January 1, 2018 – Advance Notice of Retiree Contribution Rates
Effective January 1, 2018 – Advance Notice of Retiree Subsidy Amount
Effective January 1, 2017 – Medicare Retirees Medical Coverage