top of page
Legal Notices and Plan Documents
Please see below for notices related to your healthcare and benefits provided by Living Branches.
High Deductible Plan Summary of Benefits and Coverage (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_c87e2cb0c815413fb3048dc2a6488940.pdf)
Copay Plan Summary of Benefits and Coverage (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_f113919b87eb457fb919bbe6abaf888b.pdf)
Medical Summary Plan Description (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_45a9b0c3a32d4320a72250b88df58f57.pdf)
FSA Summary Plan Description(https://www.livingbranchesbenefits.org/_files/ugd/51ffe3_373b07e0807a4ac2a2d0c8c49b2cb18e.pdf)
Special Enrollments Rights, Marketplace information, Women's Health & Cancer Rights, and CHIP Notices(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_015160f976614c498757422a9569cc54.pdf)
Your Rights and Protections Against Surprise Medical Bills(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_9e906883a37f45baa571737ff6606e48.pdf)
FSA Plan Document (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_00d566206cb64d0eb3d5261d201635dc.pdf)
HIPAA Privacy Notice(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_c6031cf09df54a8a96ace239e58837b8.pdf)
Summary Annual Report (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_4e0bd434adad4a3f97c1359b3255637a.pdf)
Click here(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_7a90cf3cd08b40349cc3d21ebaa6ef4e.pdf)
Click here(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_8c3a91a33a0c495d844105f11fcbd593.pdf)
Medicare creditable coverage disclosure notice(https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_5822f451343542128ecfdbd14ab7ce32.pdf)
Click here (https://51ffe31a-367e-4d24-aee7-bc3a6db21df6.usrfiles.com/ugd/51ffe3_b319e07aedcb4da1a885d72f0da1e8a5.pdf)to download the form.
bottom of page