Health & Welfare
Health and Welfare Plan Documents
- Summary Plan Description (2023)
- Summary Annual Report (2020)
Medical Plans – Forms and Summary of Benefits
Medical Plans for Actives
- Address Change Form
- Kaiser HMO Enrollment Form
- Kaiser HMO Plan (2025-26)
- Anthem Blue Cross PPO Enrollment Form
- Anthem Blue Cross PPO Plan (Actives 2025-26)
Medical Plan for Apprentices
- Address Change Form
- Anthem Blue Cross PPO Enrollment Form
- Anthem Blue Cross PPO Plan (Apprentices 2025-26)
Medical Plans for Early Retirees (Age 55-64)
Medicare Supplements for Retirees (Age 65+)
- Address Change Form
- Kaiser Senior Advantage Enrollment Form (2025)
- Blue Shield of CA Medicare Supplement Enrollment Form (2025)
- Hartford Medicare Supplement Enrollment Form
- SSA Request for Employment Information L564 (for Medicare)
- Retirees in Kaiser Service Area: Kaiser Senior Advantage (2023-24)
- Retirees in California: Blue Shield of CA Medicare Supplement Plan Kit (2025)
- Retirees outside of California: Hartford Medicare Supplement (2016)
Kaiser Resources
- Kaiser website
- Chiropractic Benefits
- Calm Program (English)
- Calm Program (Spanish)
- Mindfulness and Self-Care
- My Strength Program
- Self-Care (English)
- Self-Care (Spanish)
Anthem Blue Cross Resources
- Anthem Blue Cross website
- SavRx Prescription website
- UAS Portal for Anthem EOB access
- Find an Anthem Doctor
- Cooking Suggestions
- Discounts
- Fitness Tips
- Resource Advisor
- Travel Assistance
More Benefits for Local 617 Members
Dental Care (all)
Disability (Actives only)
Health Reimbursement Account (Actives, Apprentices)
Early Retirees and Retirees can continue to use any accrued balance in their account.
- HRA Benefits for Local 617
- Navia Benefits website
- Navia list of HRA eligible expenses
- Navia instructions for online reimbursement claims
- Insurance premiums: HRA Payment Form
Life & ADD Insurance (Actives only)
Both the Life Insurance and the Accidental Death & Dismemberment benefit for Actives is $100,000. These benefits are provided through MetLife Insurance; group policy number 5374409.
Mental Health and Substance Abuse Care (Actives, Apprentices, Early Retirees)
Through the Optum EAP program, you and your dependents can get confidential help for a wide range of concerns. BeatIt! provides substance abuse services for Anthem PPO medical plan participants. Kaiser provides mental health and chemical dependency services for its members.
- Optum United Behavioral Health EAP website
- Optum Flyer
- Beat it! website or call (800) 828-3939
Miscellaneous Benefits
A full description of all benefits, including additional benefits not described on this website, are found in the Summary Plan Description and in the annual Open Enrollment Packet. Some examples include:
- Hearing Aids: One hearing exam, provided by a physician or certified audiologist, is covered every 5 years. The benefit is limited to $2,000 each 12-month period per device per ear. Apprentices and Dependents are not eligible for this benefit.
- Obstructive Sleep Apnea: Treatment for Actives with either Anthem Blue Cross or Kaiser is provided by Aloha Sleep Group; see flyer.
- Orthotics: Medically necessary orthotic devices are covered once every twelve months for Actives with Anthem Blue Cross. Kaiser provides orthotics to their members.
Vision Care (all)
Kaiser provides vision care for all Local 617 members who are enrolled in Kaiser. A VSP Plan is provided for all other Local 617 members.
- VSP website
- VSP Benefit Summary and Using Your Benefit (2014)
- VSP Grievance online submission
Wellness Programs (Actives, Early Retirees)
BaySport provides nutrition counseling, complementary injury checks, health screenings, health coaching, and more to Actives, Early Retirees, and their spouses.
Pension
Forms
- Address Change Form
- Application for Health Coverage as a Retiree
- Beneficiary Designation
- Electronic Deposit Form (EFT for pension payments)
- Loan Application (2024)
- Rollover Elections – Married
- Rollover Elections – Single
- Retirement Application (2024)
- Required Minimum Distributions
- Tax Withholding, Federal (IRS website)
- Tax Withholding, State (CA EDD website)
- Tax Withholding, State (Spanish) (CA EDD website)
Pension Documents
- Summary Plan Description (2024)
- Summary Annual Report (2020)
- Comparison of Pension Funds (2019)
- Sample Qualified Domestic Relations Order (QDRO)
More Pension Information
Useful Links
- NWPS Portal for 401K Access
- National Electrical Benefit Funds
- IBEW Important Links
- Social Security Administration website
- RMD Calculator (investor.gov website)