Secure Area - Administrative District Representatives - Secure Area - Administrative District Representatives - Secure Area

	EGYPTIAN AREA SCHOOLS EMPLOYEE BENEFIT TRUST
ADMINISTRATIVE HOME

Administration Manual

1. Health Plan

   • A,B,C,HDHP Comparison with rates as of 09-01-14.pdf
   • Plan E comparison with rates as of 09-01-14.pdf
   • PLAN A effective 1-1-15 SCHEDULE OF BENEFITS.pdf
   • PLAN B effective 1-1-15 SCHEDULE OF BENEFITS.pdf
   • PLAN C effective 1-1-15 SCHEDULE OF BENEFITS.pdf
   • Plan HDHP Effective 1-1-14 SCHEDULE OF BENEFITS
   • PLAN HDHP effective 1-1-15 SCHEDULE OF BENEFITS.pdf
   
   

2. UniCare Tier I and Tier II Participating Providers

• You may access Network Providers at www.egtrust-unicare.com website to find a participating provider or contact your Egyptian Area Schools Care Coordinator at (855) 452-9997.



3. Prescription Drug Program ~ Express Scripts

• CVS Caremark Performance Drug List 2015.pdf
• CVS Medications Requiring Prior Authorization for Medical Necessity 2015.pdf
• CVS Step Therapy Drug List 2013
• Caremark Retail Out of Network 90 Retail Pharmacy List 2013
• HDHP PREVENTATIVE CARE DRUG LIST 2015.pdf



4. Voluntary Dental ~ Delta Dental

• High Plan Summary
• Low Plan Summary
• Finding a Network Dentist
• Member Connection
• Enhanced Benefits Program



5. Basic Life & Optional Life ~ Lincoln Financial

• Optional Life Brochure
• Life Claim Form
• Extension Of Death Benefits Application
• Evidence of Insurability
• Continuation Of Coverage
• Conversion Brochure
• Beneficiary Form



6. Voluntary Vision ~ UniCare

   • Vision Summary of Benefits
   • Vision Out of Network Claim Form
   • UniView Vision Benefits Brochure
   • Healthy Extensions Flyer



7. HIPAA

• Notice of Privacy Practices
• HIPAA Authorization CHC 8-12



8. Employee Forms/Documentation

   • Enrollment Form ALL PRODUCTS 2014.pdf
   • Change Enrollment Form ALL PRODUCTS 2014.pdf
   • Enrollment Notice - 12 month notice to change health plan 2014.pdf
   • Understanding Your Member Statement
   • Prescription Drug Claim Form
   • HIPAA Authorization CHC 8-12



9. Legal Documents

   • By-Laws of the Board of Managers
   • Declaration of the Trust
   • Funding Agreement



10. COBRA




11. Billing - Enrollment

    • Billing Invoice Payment



12. Employer Forms/Documentation

    • Enrollment Notice - 12 month notice to change health plan 2014.pdf
    • Egyptian Master Rates 9-1-14.pdf
    • Communication Guide 3-13-15.pdf
    • Supply Request Form effective 1-1-15.pdf