Bakers Union & FELRA

Downloads (Forms)

Notice of Surprise Billing Protections
Bakers Union and FELRA Enrollment form
Statement of Privacy
Student Certification Form
Subrogation Agreements
Weekly Accident and Sickness Claim Form
covid-19-test-kit-reimbursement-form
Delta Dental Evidence of Coverage
2023 Premium Formulary Exclusions – Standard
HIPAA Authorization Form

For Your Benefits Newsletter

April 2021
October 2019
April 2019
September 2018
September 2017
March 2017
September 2016
December 2013
January 2013
July 2012
January 2012
July 2011

 Summary Plan Description Booklets

Bakers Union and FELRA Health and Welfare SPD
SMMs (Benefit Changes) to Health & Welfare SPD

Useful Numbers

Delta Dental: 1-800-932-0783

Useful Links

CIGNA HealthCare
Care Allies
Optum Rx
Premium Formulary
Delta Dental
Group Vision Services

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.

Cigna In Network Machine Readable Files

Bakers FELRA 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.