Plan Documents and Benefit Updates
Summary Plan Description
- Active Plan 1 - restated 1/1/2020
- Active Plan 2 - restated 10/1/2004
- Active Plan 3 - restated 10/1/2004
- Active Plan 4 - restated 10/1/2004
- Delta Dental Benefits Booklet
Summary of Benefits & Coverages
Notice of Benefit Changes
- 01/2025 Summary of Material Modification – Reimbursable HRA for Non Network Expenses – Active Plan 1
- 07/2024 Summary of Material Modification – Death Benefit Beneficiary Designation – Active Plan 1
- 07/2024 Summary of Material Modification – Death Benefit Beneficiary Designation – Active Plan 2, 3, 4
- 05/2024 Summary of Material Modification – Physical Therapy Treatment – Active Plan 1
- 05/2024 Summary of Material Modification – Physical Therapy Treatment – Active Plan 2, 3, 4
- 04/2024 Summary of Material Modification – Diabetes Medication – Active Plan 1
- 04/2024 Summary of Material Modification – Diabetes Medication – Active Plan 2, 3, 4
- 01/2024 Summary of Material Modification - LOT Benefit Increase - Active Plan 1
- 01/2024 Summary of Material Modification - LOT Benefit Increase - Active Plan 2, 3, 4
- 02/2023 Summary of Material Modification – HRA and Dependent Contraception Accutane – Active Plan 1
- 02/2023 Summary of Material Modification – Dependent Contraception Accutane – Active Plan 2, 3, 4
- 08/2022 Summary of Material Modification – HRA Benefit Increase – Active Plan 1
- 08/2022 Summary of Material Modification – No Surprises Act – Active Plan 1
- 08/2022 Summary of Material Modification – No Surprises Act – Active Plan 2
- 08/2022 Summary of Material Modification – No Surprises Act – Active Plan 3
- 08/2022 Summary of Material Modification – No Surprises Act – Active Plan 4
- 04/2022 Summary of Material Modification – Autism - Infertility - Hearing Aid PPO - COVID Test – Active Plan 1
- 04/2022 Summary of Material Modification – Autism - Infertility - Hearing Aid PPO - COVID Test – Active Plan 2, 3, 4
- 11/2021 Summary of Material Modification – HRA Benefit Increase – Active Plan 1
- 07/2021 Summary of Material Modification – Nutritional Counseling - Diabetes Programs – Active Plan 1
- 07/2021 Summary of Material Modification – Nutritional Counseling - Diabetes Programs – Active Plans 2, 3, 4
- 02/2021 Summary of Material Modification – COVID-19 Vaccines – Active Plan 1
- 02/2021 Summary of Material Modification – COVID-19 Vaccines – Active Plans 2, 3, 4
- 02/2021 Summary of Material Modification – MAP – Active Plan 1
- 02/2021 Summary of Material Modification – MAP – Active Plans 2, 3 & 4
- 02/2021 Summary of Material Modification – Bariatric, HRA & Vision – Active Plan 1
- 02/2021 Summary of Material Modification – Bariatric & Vision – Active Plans 2 & 4
- 02/2021 Summary of Material Modification – Bariatric – Active Plan 3
- 04/2020 Summary of Material Modification - COVID-19
- 02/2020 Summary of Material Modification - Rx Plan Design Change
- 03/2018 Summary of Material Modification - Disability Claims Appeal
- 04/2017 Summary of Material Modification - Smoking Cessation and Infertility Treatment Benefits
- 01/2017 Summary of Material Modification - Active Plans RX Change
- 05/2015 Summary of Material Modification - Same Sex Marriage
- 06/2014 Summary of Material Modification - Death Benefit Improvement Plan - Active Plan 4
- 06/2014 Summary of Material Modification - Active Plans
- 07/2013 Summary of Material Modification - Death Benefit Improvement Plan - Active Plan 2
- 04/2013 Summary of Material Modification - CVS Caremark "Maintenance Choice" - Active Plans 1-4
Summary Plan Description
- Retiree Plan 1 - restated 1/1/2012
- Retiree Plan 2 - restated 2/1/2005
- Retiree Plan 3 - restated 2/1/2005
- Retiree Plan 4 - restated 2/1/2005
Notice of Benefit Changes
- 06/2024 Summary of Material Modification – Death Benefit Improvement to $10,000 - Retiree Plans 1, 2, 3, 4
- 05/2024 Summary of Material Modification – Physical Therapy – Retiree Plans 1, 2, 3, 4
- 04/2024 Summary of Material Modification – Diabetes Medication – Retiree Plans 1, 2, 3, 4
- 04/2022 Summary of Material Modification – Autism - Hearing Aid PPO - At Home COVID Tests - Retiree Plans 1, 2, 3, 4
- 07/2021 Summary of Material Modification – Nutritional Counseling - Diabetes Programs – Retiree Plans 1, 2, 3, 4
- 02/2021 Summary of Material Modification – COVID-19 Vaccines – Retiree Plans 1, 2, 3, 4 Basic
- 02/2021 Summary of Material Modification – Vision - Basic Plan
- 02/2021 Summary of Material Modification – Bariatric & Vision – Retiree Plans 1, 2 & 4
- 02/2021 Summary of Material Modification – Bariatric – Retiree Plan 3
- 02/2021 Summary of Material Modification – MAP – Retiree Plans 1, 2, 3 & 4
- 04/2020 Summary of Material Modification - COVID-19
- 04/2017 Summary of Material Modification - Smoking Cessation Benefits
- 01/2017 Summary of Material Modification - Retiree Plan 1 RX Change
- 01/2017 Summary of Material Modification - Retiree Plan 2-4 RX Change
- 05/2015 Summary of Material Modification - Same Sex Marriage
- 06/2014 Summary of Material Modification - Retiree Plans
- 04/2013 Summary of Material Modification - CVS Caremark "Maintanence Choice" - Retiree Plans 1-4
- 12/2012 Summary of Material Modification - Dependent Welness Benefits - Retiree Plans 1-4
- 11/2011 Summary of Material Modification - VSP Retiree Plans
- 06/2011 Summary of Material Modification - Retiree Basic Plan
- 06/2011 Summary of Material Modification - Retiree Plan 1
- 06/2011 Summary of Material Modification - Retiree Plan 2 and 4
- 06/2011 Summary of Material Modification - Retiree Plan 3
- 03/2011 Summary of Material Modification - ERRP Cover Letter
Summary Plan Description – restated 2024.
Summary of Material Modifications
- 6/2009 Summary of Material Modification
- 3/2018 Summary of Material Modification
- 6/2019 Summary of Material Modification
- 6/2021 and 6/2022 Summary of Material Modification
- 6/2023 Summary of Material Modification
- 6/2024 Summary of Material Modification
Plan Rules and Regulations
- Restated 6/30/2014 (adopted 1/12/15)
- Notice to Interested Parties
- First Amendment effective 6/1/14, adopted 5/9/16
- Second Amendment effective 4/1/18, adopted 3/12/18
- Third Amendment effective 6/1/19, adopted 7/15/19
- Fourth Amendment effective 6/1/19, adopted 9/16/19
- Fifth Amendment effective 3/9/20, adopted 5/11/20
- Sixth Amendment effective 6/1/21 & 6/1/19, adopted 9/13/21
- Seventh Amendment effective 6/1/22, 3/9/20 & 1/1/20, adopted 7/11/22
- Eighth Amendment effective 6/1/23, 1/1/23 & 1/1/24, adopted 7/17/23
- Ninth Amendment effective 6/1/14 (clarifying) , adopted 1/15/24
- Tenth Amendment effective 6/1/24, adopted 7/15/24
QDRO
- QDRO Procedures – Procedures for determining and implementing Qualified Domestic Relations Orders.
- QDRO Guidelines for Separate Interest - Follow these guidelines for participants who have not yet retired.
- QDRO Guidelines for Shared Interest - Follow these guidelines for participants who already receive pension benefits.
Disqualifying Employment