2025 PLANS

HHI Kaiser Rx Formulary for Jade, Topaz, Onyx, Virtual Plans

HHI Kaiser Rx Formulary for Sapphire, Emerald, Opal, HMO HSA, Pearl, Z2, Quartz, Zircon, Ruby, Diamond, Silver, PPO HSA

2025 Kaiser Plans One Page Summary

NEW! – 2025 HMO Z2 5000 SBC

NEW! – 2025 HMO Z2 5000 Benefit Summary

NEW! – 2025 HMO Silver 3000 SBC

NEW! – 2025 HMO Silver 3000 Benefit Summary

NEW! – 2025 PPO HSA 2500 SBC

NEW! – 2025 PPO HSA 2500 Benefit Summary

2025 Access PPO Diamond 500 SBC

2025 Access PPO Diamond 500 Benefit Summary

2025 Access PPO Emerald 1000 SBC

2025 Access PPO Emerald 1000 Benefit Summary

2025 Access PPO Sapphire 1500 SBC

2025 Access PPO Sapphire 1500 Benefit Summary

2025 Core HMO Pearl 2500 SBC

2025 Core HMO Pearl 2500 Benefit Summary

2025 Access PPO Ruby 3000 SBC

2025 Access PPO Ruby 3000 Benefit Summary

2025 Access PPO Opal 5000 SBC

2025 Access PPO Opal 5000 Benefit Summary

2025 Core HMO Onyx 5000 SBC

2025 Core HMO Onyx 5000 Benefit Summary

2025 Core HMO Jade SBC

2025 Core HMO Jade Benefit Summary

2025 Core HMO Topaz 5000 SBC

2025 Core HMO Topaz 5000 Benefit Summary

2025 HSA Core 2500 SBC

2025 HSA Core 2500 Benefit Summary

2025 Access PPO Quartz 2500 SBC

2025 Access PPO Quartz 2500 Benefit Summary

2025 Core HMO Zircon 5000 SBC

2025 Core HMO Zircon 5000 Benefit Summary

2025 Virtual Plus 1000 SBC

2025 Virtual Plus 1000 Benefit Summary

2025 Virtual Plus 2000 SBC

2025 Virtual Plus 2000 Benefit Summary

2025 Virtual Plus 3000 SBC

2025 Virtual Plus 3000 Benefit Summary

2025 Virtual Plus 5000 SBC

2025 Virtual Plus 5000 Benefit Summary

2025 PLANS

Aetna Rx Formulary

HHI AWH 1500 70/50 RX3

HHI AWH 3000 80/50 RX3

HHI AWH 6000 70/50 RX3

HHI AWH QHDHP 2500 80/50 TIF RX7

HHI PPO 1500 70/50 RX3

HHI PPO 1500 80/50 RX2

HHI PPO 2000 80/50 RX4

HHI PPO 2500 80/50 LXCP RX3

HHI PPO 3000 80/50 RX3

HHI PPO 3500 90/50 FF RX5

HHI PPO 5000 70/50 LXCP RX3

HHI PPO 5500 70/50 FF RX5

HHI PPO 6000 70/50 ERAD RX4

HHI PPO 6000 70/50 RX3

HHI PPO 7700 100/50 RX5

HHI PPO QHDHP 2500 80/50 TIF RX7

HHI PPO QHDHP 5000 70/50 EMB RX8

2025 Plans

HHI 2025 Benefit Summary – Vision Plans

HHI 2025 Ameritas Vision Plan 1

HHI 2025 Ameritas Vision Plan 2

HHI 2025 Ameritas Vision Plan 3

HHI 2025 Ameritas Vision Plan 4

HHI 2025 Ameritas Vision Plan 5

HHI 2025 Ameritas Vision Plan 6

HHI 2025 Ameritas Vision Plan 7

HHI 2025 Ameritas Vision Plan 8

HHI 2025 Ameritas Vision Plan 9

HHI 2025 Ameritas Vision Plan 10

VSP English Vision Claim Form

EyeMed English Vision Claim Form

Ameritas Vision Claim Form (English)

Ameritas Vision Claim Form (Spanish)

Ameritas Vision Enrollment Waiver Form

2025 Plans

Ameritas Vision Plan 1 (Spanish)

Ameritas Vision Plan 2 (Spanish)

Ameritas Vision Plan 3 (Spanish)

Ameritas Vision Plan 4 (Spanish)

Ameritas Vision Plan 5 (Spanish)

Ameritas Vision Plan 6 (Spanish)

Ameritas Vision Plan 7 (Spanish)

Ameritas Vision Plan 8 (Spanish)

Ameritas Vision Plan 9 (Spanish)

Ameritas Vision Plan 10 (Spanish)

2025 Plans

HHI 2025 Willamette Plan Comparison

HHI 2025 Benefit Summary – Willamette Dental HIGH Option

HHI 2025 Benefit Summary – Willamette Dental LOW Option

HHI 2025 Benefit Summary – Ameritas Dental

Ameritas Dental Claim Form (English)

Ameritas Dental Claim Form (Spanish)

Ameritas Dental Enrollment Waiver Form

VIMLY Census Template

HHI 2025 Participation Agreement

HHI 2025 Enrollment and Change Form (English)

Generic ACH Form

Transamerica Basic Life Beneficiary Form

Waiver of Health Coverage (English)

Waiver of Health Coverage (Español)

Domestic Partner Form

Notice of Late Submission and Request for Processing Exception

SIMON Access Request Form

2025 PLANS

Ameritas Benefit Summary Plan 1

Ameritas Benefit Summary Plan 2

Ameritas Benefit Summary Plan 3

Ameritas Benefit Summary Plan 4

Ameritas Benefit Summary Plan 5

Ameritas Benefit Summary Plan 6

Ameritas Benefit Summary Plan 7

Ameritas Benefit Summary Plan 1 – ortho

Ameritas Benefit Summary Plan 2 – ortho

Ameritas Benefit Summary Plan 3 – ortho

Ameritas Benefit Summary Plan 4 – ortho

Ameritas Benefit Summary Plan 5 – ortho

Ameritas Benefit Summary Plan 6 – ortho

Ameritas Benefit Summary Plan 7 – ortho

Life Insurance Benefit Summary

EAP Benefit Summary

Teladoc Benefit Summary

EAP Benefit Summary (Spanish)

Teladoc Benefit Summary (Spanish)

TransAmerica Death Claim Form

Kaiser Permanente Washington Customer Service: (888) 901-4636

Ameritas Customer Service: 800.487.5553

Willamette Customer Service: 855.433.6825

TransAmerica Customer Service: 800.797.2643

Teladoc Customer Service: 800.835.2362

ComPsych Customer Service: 877.357.4322

Vimly Benefit Solutions: 206-456-9940

H.I.H.I.T.: 866-897-0488