Documents

On This Page

Printed Forms and Templates

• United Healthcare Medicare Advantage Plan Documents
  Documents and forms related to the United Healthcare Medicare Advantage Plan for retirees
• Long-Term Disability Insurance Documents
  Long-term disability insurance application, flyer and privacy notice.
• Legal Insurance
  Legal insurance for employees is offered through MetLife.
• Anthem Medical Insurance Documents
  Anthem Medical Insurance plan information and enrollment forms for City and Police Division employees.
• The Standard Life Insurance Documents
  Documents pertaining to Life Insurance offered through The Standard Life Insurance Company
• Health Coverage Waiver Form
  Complete only if you do not want coverage under the City Health Plan
• Dental Insurance Enrollment Forms
  Enrollment forms for Delta Dental and Dental Source insurance plans.

Laws Bills and Policies

• HIPAA Privacy Notice
  This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Informational Pages

• Documents for New Employees
  Benefit information documents for new employees, including the new hire benefit enrollment packet and table of insurance start dates
• Creditable Coverage Notice Prescription Drug Coverage and Medicare Part D
  Information about Medicare and prescription drug coverage.
• Premium Assistance Under Medicaid and the Children’s Health Insurance Program Notice
  If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs.
• Anthem Summary of Benefits
  Summary of benefits for Anthem health insurance plans.
• Delta Dental Plan Documents
  Schedule of benefits for employees enrolled in Delta dental insurance plan.
• Dental Source Plan Documents
  Schedule of benefits for employees enrolled in Dental Source dental insurance plan.
• City of St. Louis Benefit Premium Only Plan (POP)
  Information Regarding the Premium Only Plan, A Section 125 Cafeteria Plan
• Premium Only Plan Documents
  Document Pertaining to the Premium Only Plan Information
• The Standard Portability Options
  Please see the attachments for The Standard Insurance Portability Options along with the application.
• Express Scripts Mobile App, Delivery, and Generics
  Information on Express Scripts mobile app, home delivery, and generic prescriptions.
• Condensed Summary of Benefits
  Condensed summary of benefits for City and Police Division medical plans
• Express Scripts Formulary: Preferred Drug List Exclusions
  List of certain brand-name medications and compound drugs that may not be covered under the Express Scripts Plan
• Anthem Certificate of Coverage
  The Anthem Health Certificates of Coverage provide information on your rights and obligations, how to get medical care, what services are covered and not covered and what portion of costs you will be required to pay.
• COBRA Documents and Forms
  Documents and forms for City of St. Louis employees, Police Division employees and retirees interested in continuation of coverage through COBRA.
• Women's Health and Cancer Rights Act
  The Women’s Health and Cancer Rights Act (WHCRA) provides protections for individuals who elect breast reconstruction after a mastectomy,
• Vision Discount
  A vision discount for City employees is offered through Crown Vision Center.

Meeting Materials

• City of Saint Louis Health Insurance Committee Meeting December 12, 2022
  Agenda and minutes for City of Saint Louis Health Insurance Committee Meeting December 12, 2022
• City of Saint Louis Health Insurance Committee Meeting February 10, 2022
  City of Saint Louis Health Insurance Committee closed meeting agenda for February 10, 2022
• City of Saint Louis Selection Committee Meeting for Dental Provider
  Meeting Agenda for The City of Saint Louis Selection Committee Meeting for Dental Provider
• Post Retiree Health Plan Selection Committee Meeting Agenda
  Post Retiree Health Plan Selection Committee Meeting
• City of Saint Louis Health Insurance Committee March 10, 2021 Meeting
  Agenda for the City of Saint Louis Health Insurance Committee Meeting on March 10, 2021
• City of Saint Louis Selection Committee for Bidding for City Legal Insurance Plan
  City of Saint Louis Selection Committee for Bidding for City Legal Insurance Plan Open Agenda
• City of Saint Louis Selection Committee Meeting for Fitness Equipment Maintenance and Repair Services 12/21/20 Agenda
  City of Saint Louis Selection Committee Meeting for Fitness Equipment Maintenance and Repair Services 12/21/20
• City of Saint Louis Health Insurance Committee Meeting December 15, 2020 Open Meeting Agenda
  City of Saint Louis Health Insurance Committee Meeting December 15, 2020 Open Agenda
• City of Saint Louis Selection Committee Meeting for Fitness Equipment Maintenance and Repair Services Meeting Agenda
  Agenda for City of Saint Louis Selection Committee Bidding for Fitness Equipment Maintenance and Repair Services Meeting on Friday, October 30, 2020 at 4:00 p.m.
• City of Saint Louis Health Insurance Committee Annual Review of Health Insurance and Pharmacy Plans Meeting Agenda
  Meeting Agenda for the City of Saint Louis Health Insurance Committee Annual Review of Health Insurance and Pharmacy Plans
• Fitness Equipment Maintenance Meeting Agenda
  City of Saint Louis Selection Committee for Bidding for Fitness Equipment Maintenance and Repair Services
• Health Insurance Committee Meeting Agenda 02/18/2020
  City Health Insurance Committee Meeting Agenda for Tuesday, February 18, 2020
• City Health Insurance Committee Meeting Agenda February 6, 2020
  Agenda for the February 6, 2020 Health Insurance Committee meeting.
• January 23 2020 Wellness Vendor Selection Committee Meeting Materials
  Agenda for the January 23, 2020 Wellness Vendor Selection Committee Meeting
• Healthcare Committee Meeting Agenda 12/12/19
  Health Care Committee Meeting Agenda Document for 12/12/19