Documents and Forms

Please see below for HPAE RMT Documents and Forms.

How to File a Claim

• How To Submit Claims

PBS BeneCard

• PBS BeneCard Account Access Instructions
• PBS Debit Card Election Form
• Debit Card Information/Card Jacket

Documents and Forms

• Summary Plan Description
• Plan Document
• Investment Policy Statement
• Participant Information Card
• Claim Reimbursement Form

Frequently Asked Questions

• HPAE RMT FAQs
• Annual Participant Statement FAQs

Plan Amendments and SMM's

• SMM Ammendments No. 8 & 9
• SMM Ammendment No. 10
• SMM Ammendment No. 11
• SMM Ammendment No. 12
• SMM Ammendments No. 13 & 14
• SMM - Monthly Verification of Premiums
• SMM - Unit Multiplier Increase
• SMM Ammendment No. 15

Plan Statements and Notices

• HIPAA Privacy Notice
• Summary Annual Report