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Claim Forms and Required Notices

Healthcare Claim Forms
CVS/Caremark
- Order prescriptions by mail Note: All plans except Kaiser, HMSA & Triple S
- CVS Caremark Prescription Drug Reimbursement Form
HSA Transfer Forms
- Transfer Your HSA TO Pearson’s Administrator
- Transfer Your HSA FROM Pearson’s Administrator
Summary Plan Description – Welfare Plan
Summaries of Benefits Coverage (SBCs)
Short-term Disability
- Short-term Disability Policy
HIPAA
- HIPAA Special Enrollment Notice
- HIPAA Privacy Notice
General Notice of COBRA Continuation Rights
- General Notice of COBRA Continuation Rights
Other Health & Welfare Legal Notices
Retirement Summary Plan Descriptions (SPDs)
- Summary Plan Description – Retirement 401(k) Plan
- Summary Plan Description – Pension Plan
Retirement Plan Highlights
- Retirement Plan Highlights
Other Retirement Legal Notices

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