Lithographers and Photoengravers Local 285

Revised Notice of Privacy Practices

Downloads (Forms)

HIPAA Authorization Form
Mutual of Omaha Enrollment Form

Summary Plan Description Booklets

Local 285 Welfare SPD

Summary of Benefits And Coverage

2018 – 2019 SBC – Flex POS
2018 – 2019 SBC – Select DHMO
2018 – 2019 SBC – Select High HMO
2018 – 2019 SBC – Signature HMO

CIGNA DHMO

Dental Plan Schedule

 Evidence of Coverage of Booklets 2015 – 2016

2015 EOC – Select DHMO
2015 EOC – Select High
2015 EOC – Signature HMO
2015 EOC – Flexible Choice

Carriers

Kaiser Health Plans
Group Dental Services
National Vision Administrators
Graphic Communications National Health and Welfare Fund
Mutual of Omaha

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.