Resources
Publications
- 2009 Spring Active Newsletter
- 2009 Spring Retiree Newsletter
- 2009 Winter Active Newsletter
- 2009 Winter Retiree Newsletter
- Advantra Freedom 2009 Summary of Benefits
- REHP Handbook January 2009
- 2008 Medicare Open Enrollment Newsletter
- Medicare Eligible Benefit Comparison Chart
- Benefit Comparison Chart - Medicare Members - Medicare HMO
- Benefit Comparison Chart - Medicare Members - Medicare PPO
- Benefit Comparison Chart - Medicare Members - 5-County Philadelphia area
- Southeastern PA PFFS Hospital Listing
- 2008 Active Open Enrollment Newsletter
- CDHP Option - HRA IRS Covered Medical Expenses
- 2008 Non-Medicare Retiree Open Enrollment Newsletter
- Get Healthy Program Brochure 9-2008
- 2008 Summer Active Newsletter
- 2008 Summer Retiree Newsletter
- Get Healthy Health Assessment Brochure - 5-2008
- 2008 Retiree Medicare Newsletter
- 2008 Get Healthy Newsletter - January 2008
- 2008 Retiree Medical and Prescription Drug Changed - Pre 7/1/04 Retiree Members - 2008 Retiree Medical and Prescription Drug Changed - Pre 7/1/04 Retiree Members
- 2007 Open Enrollment Newsletter - Active Members
- 2007 Open Enrollment Newsletter - Non-Medicare Retirees
- 2007 Summer Benefits News - Active Members
- 2007 Summer Benefit News - Retiree Members
- 2007 Spring Benefit News - Active Members
- 2007 Spring Benefit News - Retiree Members
- 2007 Special Open Enrollment for Basic Option Members - Active
- 2007 Special Open Enrollment for CMM Option Members - Retiree
- 2006 Open Enrollment - Active Members
- 2006 Open Enrollment - Retiree Members
- 2006 Summer Active Outlook
- 2006 Summer Retiree Newsletter
- 2006 Winter Spring Active Outlook
- 2006 Winter Spring Retiree Newsletter
- 2005 Open Enrollment - Active Members
- 2005 Open Enrollment - Retiree Members
- 2005 Summer Retiree Newsletter
- 2004 Winter Active Newsletter
- 2004 Spring Retiree Newsletter
- 2003 Open Enrollment - Active Members
- 2003 Open Enrollment - Retiree Members
- Summary Plan Description - January 2005
- Benefit Comparison Chart - Active Members
- Benefit Comparison Chart - Non-Medicare Elig. Retired Prior to 7/1/04
- Benefit Comparison Chart - Non-Medicare Elig Retired After 7/1/04
- REHP Notice of Privacy Practices
- HIPAA Authorizaton to Release Protected Health Information Form
Claim Forms
- Medical Reimbursement Plan Claim Form - For pre-7/1/04 Non-Medicare HMO Members
- Prescription Drug Allergenic Extract Claim Form
- Prescription Drug Direct Claim/COB Form
- Hearing Aid Claim Form - Active Members
- PEBTF Major Medical Claim Form - Retiree Members
Forms
- COBRA Important Notice
- COBRA Important Notice for Retiree Members
- Foreign Marriage Affidavit (PEBTF-FM)
- HIPAA Authorization to Release Protected Health Information
- PEBTF-2 Employee Enrollment/Change Form
- PEBTF-2 Employee Enrollment/Change Form Instructions
- PEBTF-2A Coordination of Benefits
- PEBTF-2A Coordination of Benefits Instructions
- PEBTF-4 Other Dependent Certification
- PEBTF-6 Disabled Dependent Certification
- PEBTF-7 Student Certification Form
- PEBTF-7 Student Certification Form Instructions
- PEBTF-7 (Jan) Student Certification Form - January Certification
- PEBTF-7 (Jan) Student Certification Form Instructions
- PEBTF-11 Declaration of Spouse/Domestic Partner Health Coverage - Hired Prior to 8-1-03
- PEBTF-11 Declaration of Spouse/Domestic Partner Health Coverage - Hired on or After 8-1-03
- 2008 Open Enrollment Form for Retirees
- PEBTF-12 Domestic Partner Verification Statement and Application for Health Benefits
- PEBTF-13 Individual Domestic Partnership Termination Statement
- Student Medical Leave Application
HIPAA
- HIPAA Authorization to Release Protected Health Information Form
- PEBTF Notice of Privacy Practices
- REHP Notice of Privacy Practices
- HIPAA FAQs
Prescription Drug Plan (Active Members)
- 2009 Prescription Drug Formulary
- Allergenic Extract Claim Form
- Direct Claim/COB Form
- Prior Authorization List
- Quantity Limit List
- PEBTF Notice of Creditable Coverage
Prescription Drug Plan (Retiree Members)
- 2009 Prescription Drug Formulary
- Allergenic Extract Claim Form
- Direct Claim/COB Form
- Prior Authorization List
- Quantity Limit List
- REHP Notice of Creditable Coverage
Retiree Plan Changes
- Retiree Prescription Drug Changes Effective 2/1/08
- Retiree Plan Changes-Retired Prior to 07/01/04, Medicare Eligible
- Retiree Plan Changes-Retired Prior to 7/1/04, Non-Medicare Eligible
- Retiree Plan Changes-FAQs
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