Statement of Benefits and Coverage

SBC - 2021-2022 CoPay Gold
SBC - 2021-2022 CoPay Gold (Spanish)
SBC - 2021-2022 Classic Gold
SBC - 2021-2022 Classic Gold (Spanish)
SBC - 2021-2022 HDHP $1500
SBC - 2021-2022 HDHP $1500 (Spanish)

Summary of Benefits 

2021-2022 SOB Classic Gold
2021-2022 SOB Copay Gold
2021-2022 SOB HDHP $1500 
Health Savings Account (HSA)                 

Dental Benefits

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

Vision Benefits

Vision Provider Network             AVESIS Enrollment Form         
Benefits Summary 2021-2022    Online Eyeware

General Information

ASBA Insurance Trust Handbook 2021-2022
ASBAIT Plan Document 2021-2022
ASBA 2021-2022 Enrollment Form
SY 2021-2022 Insurance Rates

My Meritain Claims Web Access
Aetna Doc Find Flyer
Nurse Health Coaching/Disease Management Flyer
Lab Work and Costs Flyer
ASBAIT Preventive Care List

Prescription Benefits

NEW Rx Provider, April 1, 2020 CVS Caremark               CVS Prior-Authorization Information
CVS Getting Started with Mail Order                                CVS Mail Order Form