Plan Documents
| Title | Date Sort ascending | |
|---|---|---|
| 2024 UHC MAPD PPO Provider Access Information Retirees, Retirees with Medicare, 2024 |
Download | |
| 2024 Certification of Federal Tax Dependent Status Declaration Form (Domestic Partner or Child) City & County of SF Employees, SF Unified School District Employees, City College of SF Employees, Municipal Executive Employees, Retirees, 2024, 2023 |
Download | |
| 2024 UHC Choice Plus Medicare-Eligible Not Enrolled Summary of Benefits & Coverage (Outside of CA) Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, UnitedHealthcare, UHC Medicare Advantage PPO, UHC PPO - Companion Plan, 2024 |
Download | |
| 2024 UHC Choice Plus Medicare-Eligible Not Enrolled Summary of Benefits (Outside of CA) Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, UnitedHealthcare, UHC Medicare Advantage PPO, UHC PPO - Companion Plan, 2024 |
Download | |
| 2024 UHC Select Plus and Choice Plus Medicare-Eligible Not Enrolled Summary Plan Description Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, UHC Medicare Advantage PPO, UHC PPO - Companion Plan, 2024 |
Download | |
| 2025 Commissioner Health Benefits Enrollment Application Fillable Form City & County of SF Employees, Health Net CanopyCare HMO, Blue Shield of California, Access+ HMO, Trio HMO, Blue Shield of California PPO, Kaiser Permanente HMO, VSP Vision, 2025 |
Download | |
| 2024 P&A Group Flexible Spending Account Claim Form City & County of SF Employees, Municipal Executive Employees, Superior Court of SF Employees, 2024 |
Download | |
| 2024 Kaiser Permanente Senior Advantage (HMO) Washington Medicare Retiree Evidence of Coverage Retirees, Retirees with Medicare, Kaiser Permanente Senior Advantage HMO - Multi-Region, 2024 |
Download |