Forms & Documents
Download brochures, enrollment forms, and important documents
24 document(s) found
Archives
Dental & Vision
Dental & Vision Enrollment Form 2025New
Enrollment application for standalone dental & visionAll2025
Dental & Vision Rate Sheet 2025
Monthly premium rates for dental and vision coverageAll2025
Dental Plan Benefits Summary
Detailed dental coverage and network informationAll
Standalone Dental & Vision Plan Overview
Complete guide to standalone dental and vision coverageAll
Vision Plan Benefits Summary
Vision coverage details including VSP networkAll
Enrollment Form
General Information
SPD - HBA Pre 65 Summary Plan DescriptionNew
Complete Summary Plan Description for HBA Pre-Medicare plansPre-652025
SPD - HBA Pre 65 Summary Plan Description
Complete Summary Plan Description for HBA Pre-Medicare plansPre-652024
Contact & Address Update Form
Update your contact informationAll
Eligibility Guidelines
Who is eligible for First Responders VEBA coverageAll
HIPAA Privacy Notice
Notice of privacy practicesAll
VEBA Trust Overview
Introduction to the First Responders VEBA TrustAll
Plan Brochure
Rate Sheet
Summary of Benefits
HBA Basic Plan Summary of Benefits 2025
Detailed benefits summary for HBA Basic planPre-652025
HBA Bronze Plan Summary of Benefits 2025
Detailed benefits summary for HBA Bronze planPre-652025
HBA Plus Plan Summary of Benefits 2025
Detailed benefits summary for HBA Plus planPre-652025
HBA Silver Plan Summary of Benefits 2025
Detailed benefits summary for HBA Silver planPre-652025
HBA Ultra Plan Summary of Benefits 2025
Detailed benefits summary for HBA Ultra planPre-652025
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