MemberXG Benefit system
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Summary Plan Description Booklets
FELRA Plan I SPD
Insert to Plan I SPD
FELRA Plan I Retiree SPD
Insert to Plan I Retiree SPD
FELRA Active Plan X SPD
Insert to Plan X SPD
FELRA Active Plan XX SPD
Insert to Plan XX SPD
FELRA Plan XXX SPD
Insert to Plan XXX
FELRA Active Plan XL SPD
Insert to Plan XL SPD
CORONAVIRUS (COVID-19) SUMMARY OF MATERIAL MODIFICATIONS
FELRA Active Plan SMM – COVID Coverage Changes
FELRA Retiree Plan SMM – COVID Coverage
Download Summary of Benefits and Coverage
FELRA Plan 1 2024 SBC
FELRA Plan X 2024 SBC
FELRA Plan XX 2024 SBC
FELRA Plan XXX 2024 SBC
Kaiser Plans I & X 2024 SBC
Kaiser Plans X & XX 2023-2024 SBC
Benefit Summaries
Open Enrollment
Kaiser Permanente 2022-2023 Open Enrollment: Plans I & X (enrolled)
Kaiser Permanente 2022-2023 Open Enrollment: Plans XX & XXX
Downloads (Forms)
Accident & Sickness Application
Coordination of Benefits Form
HIPAA Authorization Form
LabCorp Facility List
Notice of Continuation or Termination of Disability for Group Accident & Sickness Benefits
Subrogation Agreements
2023 NPF with Exclusions and alternatives
Dentegra Certificate of Coverage Plan I
Dentegra Certificate of Coverage Plan I Retiree
Dentegra Certificate of Coverage Plan X
Dentegra Certificate of Coverage Plans XX, XXX and XL
Important Notices
FELRA – ACA Preventive Services
Notice of Privacy Practices
Notice of Creditable Coverage
Notice of Surprise Biling Protections
Retiree Information
FELRA Non-Discrimination Notice
FELRA Retiree Co-Pay Rate Chart – Jan. 2019
Useful Links
Superior Vision
CareFirst PPO
Dentegra
Conifer Website
Kaiser Permanente
Express Scripts
UFCW Local 400
UFCW Local 27
Carelon Behavioral Health
Useful Numbers
Express Scripts 800-903-8325
Dentegra 877-280-4204
Superior Vision 800-507-3800
Carelon Behavioral Health Options 800-353-3572
Conifer Health Solutions – (800) 459-2110
Pre Certification – (833) 778-9806
For Your Benefit Newsletters
March 2022
December 2021
September 2021
June 2021
March 2021
December 2020
September 2020
June 2020
March 2020
December 2019
September 2019
June 2019
March 2019
December 2018
September 2018
June 2018
March 2018
December 2017
September 2017
June 2017
March 2017
December 2016
September 2016
June 2016
March 2016
December 2015
September 2015
June 2015
March 2015
December 2014
September 2014
June 2014
March 2014
December 2013
September 2013
June 2013
March 2013
December 2012
September 2012
June 2012
March 2012
Transparency in Coverage: Machine Readable Files
The links below lead to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and include negotiated service rates between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators and application developers to more easily access and analyze data.
FELRA & UFCW In-Network Machine Readable File
FELRA & UFCW Allowed Amounts Machine Readable File
Carelon Behavioral Health In-Network Machine Readable File
Carelon Behavioral Health Allowed Amounts Machine Readable File
These forms are published on this page by Associated Administrators, LLC
on behalf of the Client Fund and are meant solely for the use of their participants.