Health Trust Benefit Documents

Open Enrollment Letter

Open Enrollment will be conducted April 1 through May 17, click the link for details.

2013 Open Enrollment Letter

Plan Summary Documents

See the FOP Health Trust document links below. Requires free Adobe reader (link at bottom of the page).

Fraternal Order Choice Plus High 2012

Fraternal Order Choice Plus Low 2012

Benefit Summaries

2013 FOP Choice Plus High Option Benefit Summary

2013 Choice Plus Low Option Benefit Summary

Vision Benefit Summary 2011

Dental Benefit Summary 2011

Forms

Domestic Partner Benefits How To Apply

Domestic Partner FOP Health Trust Affidavit 032012

Domestic Partner Tax Dep Cert 2012

Mail Order Form prescription  RX mail Order Form - Medco

Mail Order Prescription Fax   RX  Fax  Form

Medical Claim form

UHC Enrollment Form SSN

Annual Rights Notice

COBRA/HIPAA Rights Notices

 ( click icon to get free adobe PDF reader)