Adventist Health Employee Health Plan Benefits

View documents and forms from a previous plan year at the links below

2022 Benefits 2021 Benefits

Medical benefits

2023 Benefits at-a-Glance

2023 Benefits Guide

California Medical Benefits

• Side by side benefit comparison
• Summary of Benefits and Coverage (SBC)
• Summary of Benefits and Coverage (SBC) – AHRO and AHMC associates
• Summary Plan Description (SPD)
• Summary Plan Description (SPD) - AHRO and AHMC associates

Medical Benefits for Members Outside of California

• Side by side benefit comparison
• Summary of Benefits and Coverage (SBC)
• Summary Plan Description (SPD)

Legal and Privacy notices

• Omnibus
• Privacy notice
• Balance Billing Disclosure

Global Emergency Services

• Global Emergency Services

Pharmacy benefits

• Pharmacy Benefit
• Zero Dollar Copay Medication List
• In-house and Community Partner Pharmacy List
• OptumRx Formulary
• OptumRx Claim Form
• How to create an OptumRx account
• Preventive Care Medications
• Free glucose monitor

Forms

• Prior Authorization/Unavailable Services Request form
• Medical Claim form
• OptumRx Claim Form
• Coordination of Benefits/Other Insurance form
• General Authorization Designation of Personal Representation and Email Consent form

Flexible Spending Account

For claims and additional information:

• Visit EBCFlex.com
• Call (800) 346-2126

Dental

For claims and additional information:

• Visit DeltaDentalins.com/AH
• Call (888)335-8227

Vision

For claims and additional information:

• Visit Adventist.VSPForMe.com
• Call (800) 877-7195