ST. LOUIS PLAN B FUND

PLAN DOCUMENTS

Delta Dental Plan B

Summary of Benefits & Coverage, 2023

Summary of Benefits & Coverage, 2024

FORMS

2020 Annual Claim Form

2021 Annual Claim Form

2022 Annual Claim Form

2023 Annual Claim Form

2024 Annual Claim Form

MAILINGS

10/20/23 Notice of Children's Health Insurance Program (CHIP)

10/20/23 Notice of Prescription Drug Coverage and Medicare

10/20/23 Notice of the Plan's Use and Disclosure of PHI

10/20/23 Women's Health and Cancer Rights Act

10/20/23 Newborns' and Mothers' Health Protection Act

10/20/23 Surprise Medical Billing Notice 

6/26/23 COBRA Rate Change, MO Plan B

1/23/23 Change to Cigna Notification

11/30/22 Notice of Children's Health Insurance Program (CHIP)

11/30/22 Notice of Prescription Drug Coverage and Medicare

11/30/22 Notice of the Plan's Use and Disclosure of PHI

11/30/22 Women's Health and Cancer Rights Act

11/30/22 Newborns' and Mothers' Health Protection Act

11/30/22 Surprise Medical Billing Notice 

6/15/22 COBRA Rate Change, MO Plan B

12/1/21 Summary of Material Modification-No Surprises Act

11/29/21 Summary Annual Report - Welfare

11/16/21 Surprise Medical Billing Annual Notice

10/18/21 Summary of Material Modification Specialty Medications

10/18/21 Notice of Children's Health Insurance Program (CHIP)

10/18/21 Notice of Prescription Drug Coverage and Medicare

10/18/21 Notice of the Plan's Use and Disclosure of PHI

10/18/21 Women's Health and Cancer Rights Act

10/18/21 Newborns' and Mothers' Health Protection Act

6/9/21 COBRA rate change

3/24/21 Summary of Materials Modification for Weight Loss Benefit

3/24/21 Temporary Changes to Claims, Appeals & COBRA revised

3/5/21 Temporary Changes to Claims, Appeals & COBRA

2/26/21 Change to New PBM AnWINS Rx

2/26/21 Summary of Materials Modification AnWINS Rx Changes

11/23/20 Notice of Children's Health Insurance Program (CHIP)

11/23/20 Notice of Prescription Drug Coverage and Medicare

11/23/20 Notice of the Plan's Use and Disclosure of PHI

11/23/20 Women's Health and Cancer Rights Act

11/23/20 Newborns' and Mothers' Health Protection Act

6/15/20 COBRA Rate Changes, 2020

8/29/19 Summary of Material Modification Re: Gene Therapy

11/21/18 Annual Claim form

11/21/18 Summary of Benefits and Coverage

11/21/18 Summary of Material Modification OOP and ER Coverage

FIND A PROVIDER

Cigna OAP (Open Access Plus)

AmWINS RX

Delta Dental

 

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