Forms & Plan Information

• Health Summary Plan Description
• SMM Gender Affirming Care
• Summary Annual Report

• Plan A Summary of Benefits and Coverage – (family coverage, full benefits)
• Plan B Summary of Benefits and Coverage – (employee only coverage, no dental)
• Primary Care with Vera
• Teladoc Flyer – (all plans)

• Temporary ID Card – WA Residents Plan A/B
• Temporary ID Card – OR Residents Plan A/B

• Willamette Dental Plan Summary of Benefits
• Pacific Dental Alliance Plan Summary of Benefits

• Vision Plan Summary

• Member Assistance Program (MAP) Flyer
• Medicare Eligibility Consulting Flyer

• Pension Summary Plan Description
• Green Zone Status and Benefit Improvements

• Enrollment Form
• Sav-Rx Member Claim Form
• Aetna Medical Claim Form
• Eye-Med Out of Network Claim Form
• Weekly Disability Benefits Application

Administration Office
Phone: (844) 411-0786

Northwest Administrators
2323 Eastlake Avenue E, Seattle, WA 98102
Website

Aetna
(800) 872-3862
Website

Vera Whole Health
(206) 580-2922
Website

Sav-Rx
Phone: (800) 228-3108
Website

Pacific Dental Alliance
Phone: (206) 232-1268
Website

Willamette Dental Group
Phone: (855) 433-6825
Website

Cigna
Phone: (800) 797-3381
Website

EyeMed
Phone: (866) 289-0614
Website

First Choice Health
Phone: (866) 372-3780
Website

Administration Office
Phone: (844) 411-0786

Northwest Administrators
2323 Eastlake Avenue E, Seattle, WA 98102
Website

KMi
Kristin Manwaring
Phone: (360) 385-4400
Website

Administration Office
Phone: (844) 411-0786

Northwest Administrators
2323 Eastlake Avenue E, Seattle, WA 98102
Website