Plan Documents
Below is a list of insurance carrier documents, including coverage detail summaries, certificates of coverage and policies. Click the link to view or print the document for the plan(s) you are currently enrolled in.
Please note: The attached documents are not a guarantee of current or future coverage. If you have specific questions regarding these documents or your coverage, please contact the insurance carrier directly.
Medical and Prescription Drug Plan
Blue Cross Blue Shield of Arizona Plan Document and Summary Plan Description
Plan Amendment and SMM to Self-Funded Medical & Prescription Plan
Dental Plan
Delta Dental Value Plan Certificate
Delta Dental Core Plan Certificate
Delta Dental Premium Plan Certificate
Vision Plan
Kaiser Permanente
Northern California
Kaiser Value Plan SPD – Northern California
Kaiser Value Plan Chiropractic Services Amendment – Northern California
Kaiser Core Plan SPD – Northern California
Kaiser Core Plan Chiropractic Services Amendment – Northern California
Kaiser Premium Plan SPD – Northern California
Kaiser Premium Plan Chiropractic Services Amendment – Northern California
Southern California
Kaiser Value Plan SPD – Southern California
Kaiser Value Plan Chiropractic Services Amendment – Southern California
Kaiser Core Plan SPD – Southern California
Kaiser Core Plan Chiropractic Services Amendment – Southern California
Kaiser Premium Plan SPD – Southern California
Kaiser Premium Plan Chiropractic Services Amendment – Southern California
Supplemental and Voluntary Benefits
Accident Insurance Certificate
Accidental Death and Dismemberment Life Policy Certificate
Hospital Indemnity Certificate