Hamburg Benefit TrustErin Holstein-financial
Julie Maxson-enrollment Debra Vertokse-retirees/COBRA Paula Litwin-secretary Amy Takacs-HTA President Please contact trustees for further information. |
|
Dental Claim Form
| claim_form.pdf |
Dental: Summary of Benefits
Summary of Benefits - effective January 1, 2016 No changes for 2017
| newamendedsummaryofbenefitsjanuary2016.docx.pdf |
Hamburg Central Teachers Association Dental Plan Evidence of Coverage
| 01382-02434_eoc_1-1-16__1_.pdf |
HIPPA Privacy Notice
| privacystatementdocument-hippa.rtf |
Changes in eligibility status (i.e. marriage, divorce,birth, etc.) must be reported to the Plan Administrator
(Julie Maxson) within 31 days following the event causing the change. If you do not change coverage when
first eligible, you may change later during "open enrollment".
(Julie Maxson) within 31 days following the event causing the change. If you do not change coverage when
first eligible, you may change later during "open enrollment".
If you are thinking of retiring and are currently enrolled in the dental program with Delta,
please contact (email) Deb Vertoske as soon as possible. Current annual rates for retirees are;
$475 single $800 family. These rates are subject to change.
please contact (email) Deb Vertoske as soon as possible. Current annual rates for retirees are;
$475 single $800 family. These rates are subject to change.
