Enrollment & Beneficiary Form
Change of Address
Delta Dental Enrollment Form
ULLICO Enrollment Form
UnitedHealthcare Enrollment Form
Authorization to Disclose PHI
VSP Enrollment Form
Group Vision Care Plan Evidence of Coverage & Disclosure Form
Summary Plan Description - July 2021
2013 HIPAA Privacy Notice
UnitedHealthcare of California Combined Evidence of Coverage and Disclosure Form
Prescription Drug Coverage and Medicare Notice
Your Rights and Protections Against Surprise Medical Bills
SignatureValue Advantage HMO Summary of Benefits and Coverage
SignatureValue Advantage HMO Schedule of Benefits
SignatureValue Harmony HMO Schedule of Benefits
SignatureValue Harmony HMO Summary of Benefits and Coverage
Inland Distribution Election Form
Declaration of Retirement
SCPT Defined Contribution Enrollment Change Form
SCPT Defined Contribution Beneficiary Designation Form
Summary Plan Description - May 2021
SCPT 401(K) Participant Notice
Paid Time Off Benefit Interim Withdrawal Form
Authorization Agreement For Direct Deposit
SMM Paid Time Off - April 2016
SMM Changes to Paid Time Off (PTO) Benefits - June 2017
401(k) Enrollment/Change/Opt-Out Form
Inactive Status Request Form
Contribution Payment Methods
Managing Contribution Benefits
Benefit information varies by Trust Funds. Please make a selection.
