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 lindsay@synodpacific.org or view the applicable Benefit Guide below.

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

ENROLLMENT FORMS	2020 SUMMARIES OF BENEFITS & COVERAGE (SBCs) & BENEFIT SUMMARIES
Medical/Dental/Vision Plans	California Medical Plans
2020 Universal Enrollment Form	Sutter 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 FSA	Outside California Medical Plans
2020 Section 125 FSA Enrollment Form	Kaiser 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 Kit	Anthem Low Dental Plan
2020 FSA Renewal Letter	Anthem Life Insurance
2020 Summary Plan Description	Resource Advisor Employee Assistance Plan
2020 FSA Main Plan Document
	Vision (VSP)
	Vision Service Plan