Plan Documents and Forms

Benefits

Benefits Information Guide—Summary Plan Description [PDF]

Anthem Medical Plans

Anthem Base California Summary Plan Description 2021 [PDF]
Anthem Base Non-California Summary Plan Description 2021 [PDF]
Anthem Base PPO Benefit Summary 2021 [PDF]
Anthem Base PPO California Summary of Benefits Coverage 2022 [PDF]
Anthem Base PPO Silfex Summary Plan Description [PDF]
Anthem Base PPO Summary of Benefits Coverage 2021 [PDF]
Anthem Base PPO California Benefit Summary 2022 [PDF]
Anthem CDHP California Summary Plan Description 2021 [PDF]
Anthem CDHP Non-California Summary Plan Description 2021 [PDF]
Anthem CDHP Silfex Summary Plan Description [PDF]
Anthem CDHP with HSA Benefits Summary 2021 [PDF]
Anthem CDHP with HSA California Benefit Summary 2022 [PDF]
Anthem CDHP with HSA California  Summary of Benefits Coverage 2022 [PDF]
Anthem CDHP with HSA Summary of Benefits Coverage 2021 [PDF]
Anthem Preventive Care Guidelines [PDF]
CVS Caremark Preventive Drug List 2020 [PDF]
CVS Caremark RX Base CDHP Summary Plan Description 2020 [PDF]
CVS Caremark RX Base PPO Summary Plan Description 2020 [PDF]

Kaiser Medical Plans

Kaiser California HMO Chiropractic 2016 Summary Plan Description [PDF]
Kaiser CDHP with HSA Northern California Benefit Summary 2021 [PDF]
Kaiser CDHP with HSA Northern California Benefit Summary 2022 [PDF]
Kaiser CDHP with HSA Northern California Evidence of Coverage 2021 [PDF]
Kaiser CDHP with HSA Northern California Summary of Benefits Coverage 2021 [PDF]
Kaiser CDHP with HSA Northern California Summary of Benefits Coverage 2022 [PDF]
Kaiser CDHP with HSA Oregon and Washington Benefit Summary 2021 [PDF]
Kaiser CDHP with HSA Oregon and Washington Benefit Summary 2022 [PDF]
Kaiser CDHP with HSA Oregon and Washington Summary of Benefits Coverage 2021 [PDF]
Kaiser CDHP with HSA Oregon and Washington Summary of Benefits Coverage 2022 [PDF]
Kaiser HMO Northern California Benefit Summary 2021 [PDF]
Kaiser HMO Northern California Benefit Summary 2022 [PDF]
Kaiser HMO Northern California Evidence of Coverage 2021 [PDF]
Kaiser HMO Northern California Summary of Benefits Coverage 2021 [PDF]
Kaiser HMO Northern California Summary of Benefits Coverage 2022 [PDF]
Kaiser HMO Oregon and Washington Benefit Summary 2021 [PDF]
Kaiser HMO Oregon and Washington Benefit Summary 2022 [PDF]
Kaiser HMO Oregon and Washington Summary of Benefits Coverage 2021 [PDF]
Kaiser HMO Oregon and Washington Summary of Benefits Coverage 2022 [PDF]
Kaiser Permanente Northwest Mail Order Pharmacy [PDF]
Kaiser Preventive Care Recommendations [PDF]

Dental

Delta Dental Enhanced Plan Benefit Summary 2021 [PDF]
Delta Dental Enhanced Plan Benefit Summary 2022 [PDF]
Delta Dental Enhanced Plan Evidence of Coverage (EOC) 2021 [PDF]
Delta Dental Premium Plan Benefit Summary 2021 [PDF]
Delta Dental Premium Plan Benefit Summary 2022 [PDF]
Delta Dental Premium Plan Evidence of Coverage (EOC) 2021 [PDF]
Delta Dental Preventive Plan Benefit Summary 2021 [PDF]
Delta Dental Preventive Plan Benefit Summary 2022 [PDF]
Delta Dental Preventive Plan Evidence of Coverage (EOC) 2021 [PDF]

Vision

VSP Base Plan Benefit Summary 2021 [PDF]
VSP Base Plan Benefit Summary 2022 [PDF]
VSP Enhanced Plan Benefit Summary 2021 [PDF]
VSP Enhanced Plan Benefit Summary 2022 [PDF]

Life Insurance and Voluntary Supplemental Insurance

Accident Insurance Overview [PDF]
Accident Plan Summary [PDF]
Critical Illness Insurance Overview [PDF]
Critical Illness Insurance Plan FAQs [PDF]
Critical Illness Outline of Coverage [PDF]
Critical Illness Plan Summary [pdf]
Hospital Indemnity Insurance Overview [PDF]
Hospital Indemnity Plan Summary [PDF]
Lam Group Life Insurance Summary Plan Description [PDF]
Silfex Group Life Insurance Summary Plan Description [PDF]

Disability Coverage

California VDI Statement of Coverage 2021 [PDF]
California Voluntary Disability Plan Summary Plan Description [PDF]
Lam Long-Term Disability Insurance Certificate [PDF]
Short-Term Disability Plan Document 2021 [PDF]
Short-Term Disability Plan Summary Annual Report (Lam) [PDF]
Short-Term Disability Plan Summary Plan Description 2021 [PDF]
Short-Term Disability Statement of Coverage 2021 [PDF]
Silfex Long-Term Disability Insurance Certificate [PDF]

Policies, Practices, and Forms

Adoption Reimbursement Form [PDF]
Leave of Absence and Accommodation Practice [PDF]
Time Off Practice [PDF]

State Supplements

Arizona State Supplement [PDF]
California State Supplement [PDF]
Idaho State Supplement [PDF]
New York State Supplement [PDF]
Oregon State Supplement [PDF]
Texas State Supplement [PDF]

Required Notices

2022 Required Notices [PDF]
Cafeteria Plan Document [PDF]
Children's Health Insurance Program (CHIP) Notice [PDF]
ESPP Prospectus [PDF]
Family and Medical Leave Act (FMLA) Notice [PDF]
Group Welfare Benefit Plan Document [PDF]
Health and Welfare Plans Summary Annual Report (Lam) [PDF]
Health and Welfare Plans Summary Annual Report (Silfex) [PDF]
Health Insurance Marketplace Notice [PDF]
HIPAA Privacy Notice [PDF]
Medicare Creditable Coverage Notice 2021 [PDF]

Retirement

401(k) Summary Plan Description [PDF]
Lam Research 401(k) Guide [PDF]