Statement of Benefits and Coverage

General Information

SBC - 2023-2024 Copay Gold
SBC - 2023-2024 Classic Gold
SBC - 2023-2024 HDHP A

SBC- 2024-2025 Copay Gold
SBC-2024-2025 Classic Gold
SBC- 2024-2025 HDHP A

ASBA Insurance Trust Handbook
ASBAIT Plan Document                             

ASBAIT 24-25 Enrollment Form

SY24-25 Insurance Rates
My Meritain Claims Web Accss
Aetna Doc Find Flyer
Nurse Health Coaching/Disease Management Flyer
Lab Work and Costs Flyer
ASBAIT Preventive Care List 

ASBAIT Take Control of Your Health

ASBAIT Level of Care  

ASBAIT Maternity Management 

Summary of Benefits

Prescription Benefits

SOB - 2023-2024 Classic Gold
SOB - 2023-2024 Copay Gold
SOB - 2023-2024 HDHP A  

SOB- 2024-2025 COPAY GOLD

SOB- 2024-2025 CLASSIC GOLD                  

SOB- 2024-2025 HDHP A

Health Savings Account (HSA)

NEW Rx Provider, April 1, 2020 CVS Caremark 
CVS Prior-Authorization Information
CVS Getting Started with Mail Order 
CVS Mail Order Form
CVS Drug Cost Tool
Generic vs Name Brand Rx.

CVS Caremark Formulary

CVS Formulary Removals and Add-Backs

Dental Benefits

Vision Benefits

Delta Dental Benefits

Delta Dental Enrollment Form    
Delta Dental Claim Form
Delta Dental Foreign Provider Reimbursement Guide

Vision Provider Network
AVESIS Enrollment Form
Benefits Summary
Online Eyeware