Plan Summaries, Enrollment Forms and FSA Info

**Please note that the below has been updated for Plan Year beginning January 1, 2020.  If you need current plan information, please feel free to contact Melinda@synodpacific.org or view the applicable Benefit Guide below**

Downloads

Synod of the Pacific's Benefit Guide for Plan Year Beginning January 1, 2020

Enrollment Forms2020 Summaries of Benefits &
Coverage (SBCs) & Benefit Summaries
Medical/Dental/Vision PlansCalifornia Medical Plans
2020 Universal Enrollment FormSutter HMO SBC | Benefit Summary

Sutter Deductible HMO SBC | Benefit Summary

Kaiser HMO SBC | Benefit Summary | Chiro Summary

Kaiser HRA SBC | Benefit Summary
Voluntary Benefits
Reliance Life/AD&D Enrollment Form, Rates & Highlights




Section 125 FSAOutside California Medical Plans
2020 Section 125 FSA Enrollment FormKaiser NW SBC | Benefit Summary
Vantage Flex Smart Phone Claim Submission Instructions
 
Vantage Flex Portal Access and Online Claim Submission

2020 FSA Reimbursement Form
2019 Medical Reimbursement Form
Anthem Dental Plans (with Life & EAP plan)
2019 Dependent Care Reimbursement Form
Anthem High Dental Plan
2020 FSA Enrollment Information KitAnthem Low Dental Plan
2020 FSA Renewal LetterAnthem Life Insurance
2020 Summary Plan DescriptionResource Advisor Employee Assistance Plan
2020 FSA Main Plan Document

Vision (VSP)

Vision Service Plan