Share This:

Health Care - Assistance Plan (HCAP) Documents

2015 HealthCare Assistance Plan (HCAP) Documents

2015 SUMMARY PLAN INFORMATION

2015 Enrollment Applications

2015 Employee Healthcare Enrollment Application | LEGACY
2015 Employee Healthcare Enrollment Application | OPTION (DEFAULT TO STANDARD PLAN) | OPTION (DEFAULT TO CURRENT PLAN)
2015 Employee Healthcare Enrollment Application | STANDARD

Search Provider network

Click here to search the Participating Provider Directory.
 

2015 WEBINARS

 Healthcare Open Enrollment for 2015 | 10/08/14
Download the Presentation (PDF 303 KB)

 Healthcare Transition for PPO and Member Services in 2015 | 10/09/14
Download the Presentation (PDF 2.7 MB)


 

2014 HealthCare Assistance Plan (HCAP) Documents


This Plan document describes the provisions of the Health Care Assistance Plan for employees of the Seventh-day Adventist Organizations of the North American Division working in the United States (“Plan”). Please refer to the North American Division Working Policy Y 22 for the supporting general philosophy of this Plan.

2014 Health Care Assistance Plan (HCAP) Document
2014 Summary of Benefits and Coverage
2013 Health Care Assistance Plan (HCAP) Document
2013 Summary of Benefits and Coverage (SBC)
2012 Health Care Assistance Plan (HCAP) Document
2011 Health Care Assistance Plan (HCAP) Document


International Documents

BlueCard World Wide Brochure English - Español
International Claim Form English - Español


Reimbursement Forms

Claims Reimbursement Request Form
BlueCard PPO Out-of-Network Reimbursement Form
Medco RX Mail Order Form
Express Scripts RX Reimbursement Form
United Concordia Dental Claim Form

United Concordia Dental Claim Form-Arizona Only
United Concordia Dental Claim Form-New York Only
United Concordia Dental Claim Form-Instructions


Eligibility Forms

Employee Health Care Enrollment Application
Employee Information Change Request Form
Employee Benefit Termination Request Form
 

DisabilityHCAP_Provider-Application-Certification

Decline Coverage for Healthcare Assistance Plan
Dependent Child Disability Certification
HIPAA Consent for Release