Plan Documents and Legal Notices

Plan Information

Plan Name: XXXX

Policy Number: #XXXX

Effective Date: XX/XX/XXXX

Network: XXXX

Medical Documents

2025 Aetna CDHP-HSA Benefit Summary

2025 Aetna CDHP-HSA Summary of Benefits & Coverage

Aetna HDHP Certificate

Aetna HDHP Schedule of Benefits

2025 Aetna EPO Benefit Summary

2025 Aetna EPO Summary of Benefits & Coverage

Aetna EPO Certificate

Aetna Prescription Drug Guide

Aetna Disabled Child Attending Physician’s Statement

Medical Claim Form

Aetna Pharmacy Management Claim Form

Aetna Request for Continuation of Coverage for Disabled Child

Aetna Rx Home Delivery Form

Aetna Transition Coverage Request (CA)

Aetna Transition Coverage Request (Non-CA)

Aetna Beginning Right Maternity Program

Aetna Discount Program Flyer

Aetna Getting Started with Teladoc

Aetna HDHP Provider Directory

Aetna Health App

Aetna Transition Coverage Request for HMO (CA)

Dental Documents

2025 Aetna Dental HMO Benefit Summary

Aetna Dental HMO Certificate

Aetna Dental HMO Certificate (NJ)

Aetna Dental HMO Evidence of Coverage

2025 Aetna Dental PPO Benefit Summary

Aetna Dental PPO Certificate

Aetna Dental PPO Schedule of Benefits

Vision Documents

2025 Aetna Vision Benefit Summary

Aetna Vision Certificate

Aetna Vision Schedule of Benefits

HSA, FSA & Commuter Documents

Inspira FSA Summary Plan Description

Inspira FSA Claim Form

Inspira Card Keep it Active Flyer

Inspira HSA & FSA Reimbursement FAQ

Inspira Commuter Benefits Flyer

Inspira Commuter Quick Reference Flyer

Inspira Commuter Benefits Reimbursement Flyer

Plan Information

Plan Name: XXXX

Policy Number: #XXXX

Effective Date: XX/XX/XXXX

Network: XXXX

Supplemental Medical Documents

Guardian Medical Accident Summary (HDHP Enrollees)

Guardian Medical Accident Summary (Non-HDHP Enrollees)

Income Protection Documents

2025 Hartford Voluntary Life and AD&D Benefit Summary

Hartford Voluntary Life and AD&D Evidence of Insurability Form (NY Only)

Hartford Voluntary Life and AD&D Premium Worksheet

2025 Hartford Voluntary Life and AD&D Benefit Summary

2025 Hartford Voluntary Life and AD&D Premium Worksheet

2025 Northwestern Mutual STD Benefit Summary

Northwestern Mutual STD Certificate

Northwestern Mutual STD Certificate Amendment

Northwestern Mutual LTD Certificate

Northwestern Mutual LTD Certificate Amendment 6

Northwestern Mutual LTD Certificate Amendment 7

Hartford Beneficiary Assist Flyer

Hartford Estate Guidance Flyer

Hartford Funeral Planning Flyer

Hartford Travel Assist Flyer

Mental Health Documents

Northwestern Mutual EAP Poster

Northwestern Mutual EAP Flyer

Northwestern Mutual EAP Benefit Summary

Compliance Notices

Annual Notices

Notice of Deadline Extension & Summary of Material Modifications

Notice of Exchange

Notice of FSA Changes

Notice of Privacy Practices

Summary Annual Reports

Summary of Material Modifications

Wrap Summary Plan Description

Plan Information

Plan Name: XXXX

Policy Number: #XXXX

Effective Date: XX/XX/XXXX

Network: XXXX

Medical Documents

2024 Aetna HDHP Benefit Summary

Aetna HDHP Certificate

Aetna HDHP Schedule of Benefits

2024 Aetna EPO Benefit Summary

2024 Aetna EPO Summary of Benefits & Coverage

Aetna EPO Certificate

Aenta Prescription Drug Guide

Aetna Disabled Child Attending Physician’s Statement

Medical Claim Form

Aetna Pharmacy Management Claim Form

Aetna Request for Continuation of Coverage for Disabled Child

Aetna Rx Home Delivery Form

Aetna Transition Coverage Request (CA)

Aetna Transition Coverage Request (Non-CA)

Aetna Beginning Right Maternity Program

Aetna Discount Program Flyer

Aetna Getting Started with Teladoc

Aetna HDHP Provider Directory

Aetna Health App

Aetna Transition Coverage Request for HMO (CA)

Dental Documents

2024 Aetna Dental HMO Benefit Summary

Aetna Dental HMO Certificate

Aetna Dental HMO Certificate (NJ)

Aetna Dental HMO Evidence of Coverage

2024 Aetna Dental PPO Benefit Summary

Aetna Dental PPO Certificate

Aetna Dental PPO Schedule of Benefits

Vision Documents

2024 Aetna Vision Benefit Summary

Aetna Vision Certificate

Aetna Vision Schedule of Benefits

HSA, FSA & Commuter Documents

Payflex FSA Summary Plan Description

Payflex FSA Claim Form

PayFlex Card – Keep it Active Flyer

PayFlex HSA & FSA Reimbursement FAQ

PayFlex Commuter Benefits Member flyer

PayFlex Commuter Quick Reference Guide

PayFlex Commuter Benefits Reimbursement Flyer

Supplemental Medical Documents

Guardian Medical Accident Summary (HDHP Enrollees)

Guardian Medical Accident Summary (Non-HDHP Enrollees)

Income Protection Documents

2024 Hartford Voluntary Life and AD&D Benefit Summary

Hartford Voluntary Life and AD&D Evidence of Insurability Form (NY Only)

Hartford Voluntary Life and AD&D Premium Worksheet

2024 Hartford Voluntary Life and AD&D Benefit Summary

2024 Hartford Voluntary Life and AD&D Premium Worksheet

2023-24 Northwestern Mutual STD Benefit Summary

Northwestern Mutual STD Certificate

Northwestern Mutual STD Certificate Amendment

Northwestern Mutual LTD Certificate

Northwestern Mutual LTD Certificate Amendment 6

Northwestern Mutual LTD Certificate Amendment 7

Hartford Beneficiary Assist Flyer

Hartford Estate Guidance Flyer

Hartford Funeral Planning Flyer

Hartford Travel Assist Flyer

Retirement Documents

Year Carrier Document Name

Mental Health Documents

Morneau Shepell EAP Online Will and Legal Form

Morneau Shepell EAP Employee Brochure

Morneau Shepell EAP Financial Support Services

Morneau Shepell EAP Legal Assistance Services

Morneau Shepell EAP MyEAP App

Morneau Shepell EAP Worklife Services

Northern Mutual EAP Poster

Northern Mutual EAP Flyer

Northern Mutual EAP Benefit Summary

Additional Benefit Documents

Year Carrier Document Name

Compliance Notices

Annual Notices

Notice of Deadline Extension & Summary of Material Modifications

Notice of Exchange

Notice of FSA Changes

Notice of Privacy Practices

Summary Annual Reports

Summary of Material Modifications

Wrap Summary Plan Description