Notices/Forms

Creditable Coverage Letter

2020 for 2021 Creditable Coverage Letter

COVID-19 Information

UHC Montoring Coronavirus 2-6-2020

Covid-19 Update 4-21-2020

Employee Enrollments, Terminations, and Changes
Enrollment and Change Form

To enroll or terminate an employee or to make employee changes please complete the attached enrollment/change form and email it to ClientServices_Billing3@mercer.com or fax it to 1-515-365-1310.

Alicia Schossow will continue to oversee HBP’s billing and enrollment processes and she will have additional team members providing support.  The old email address CBS.HBP.Billing&Eligibility@mmc.com will not be monitored after 12/31/2020. Please begin using the new email address now.

Plan Information for Newly Enrolled Employees

Claim Forms

Medical Out of Network

Pharmacy Reimbursement

Dental

VSP Vision

UHC Vision (Out of Network)

International

Life Insurance Information

Portability and Conversion at a glance

Conversion Application

Portability Application

The Standard’s Death Claim Packet

Instructions for completing the Death Claim Packet

Waiver of Group Health Benefits

Wellness Bonus Program shared by the Housing Authority of St. Louis County, MO

HBP Plan and Trust Document

Privacy Notice