Enrollment Applications

1. RIHWTF Enrollment Application 2024

Summary of Benefits and Coverage

1. Kaiser Traditional HMO #2200
2. Kaiser High (Mid) Copay HMO #2201
3. Kaiser DHMO (6265) #2202
4. Kaiser DHMO Bronze Plan (6252) #4390
5. Kaiser DHMO HSA (HMO) #8109
6. Kaiser PPO #1391
7. Basic Life and AD&D – $10,000
8. Basic Life and AD&D – $50,000
9. Basic Life and AD&D – $250,000
10. VSP Vision Plans – Standard (Low)
11. VSP Vision Plans – Premium (High)
12. Guardian Dental Plans – HMO 4000, PPO PX & PPO VZ
13. Voluntary AD&D Benefit Summary
14. Voluntary Life Benefit Summary