Plan Documents – Robbinsdale Area Schools

Plan Documents

Everything you need in one place.

Below you’ll find links to information and forms, which you can view or download and print.

If you prefer talking with a HealthEZ representative, call 888-284-7196

2026 Medical Benefit Information

Benefit Overview	Provides a high level overview of your HealthEZ medical benefits.
Copay $500/$1000 Plan SBC	Provides an easy-to-understand summary about a health plan’s benefits and coverage.
Copay $1,750/$3,500 HRA/VEBA Plan SBC	Provides an easy-to-understand summary about a health plan’s benefits and coverage.
$1,700/$4,500 HSA Plan SBC	Provides an easy-to-understand summary about a health plan’s benefits and coverage.
$1,700/$4,500 HRA/VEBA Plan SBC	Provides an easy-to-understand summary about a health plan’s benefits and coverage.
$4,500/$7,000 HSA Plan SBC	Provides an easy-to-understand summary about a health plan’s benefits and coverage.
$4,500/$7,000 HRA/VEBA Plan SBC	Provides an easy-to-understand summary about a health plan’s benefits and coverage.
2026 Summary Plan Description (SPD)	The Summary Plan Description for the plan year effective 1/1/2026 has yet to be finalized and will be posted once available. In the meantime, if you have questions on your plan's benefits, please contact the number at the top of this page.
2026 VEBA Summary Plan Description (SPD)	The Summary Plan Description for the plan year effective 1/1/2026 has yet to be finalized and will be posted once available. In the meantime, if you have questions on your plan's benefits, please contact the number at the top of this page.

2025 Medical Benefit Information

2025 Non-VEBA Plans Summary Plan Description (SPD)	Provides information on how the medical plan operates, when employees are eligible for benefits, how benefits are paid, and much more.
2025 VEBA Plans Summary Plan Description (SPD)	Provides information on how the medical plan operates, when employees are eligible for benefits, how benefits are paid, and much more.

HealthEZ Resources

Member App Instructions	Provides instructions on downloading the MyHealthEZ app and creating an online account.
Member Portal Overview	A brief video overview of your MyHealthEZ portal where you be able to find EOBs, statements, accumulator data, ID cards, and so much more.
Boost Your Baby	HealthEZ offers maternity support by providing education and resources to promote a healthy pregnancy through postpartum.
HealthEZ EZPay	Manage all your medical expenses in one simple spot with EZpay. Everything you need is at your fingertips in the free HealthEZ app.
Understanding Your ID Card	Provides an easy-to-understand summary about how to read your HealthEZ ID card.
Understanding Your Medical Expenses	Provides an easy-to-understand summary about non-embedded versus embedded plans.

HealthEZ Care Advocacy

Care Advocacy	Helping you when you need it the most.
Care Advocacy Enrollment Form	HealthEZ wants to make sure that your medical care during your health insurance transition is as seamless as possible

EZFit

EZFit Overview	EZFit from HealthEZ makes it easy for you to get credit for health club workouts.
EZFit Enrollment Form	Enroll into the EZFit program!
EZFit Reimbursement Form	Submit your health club sign in history for reimbursement!

Claim Reimbursement Forms

Medical Expense Reimbursement Form	Fill out the Medical Expense Reimbursement Form and submit to HealthEZ when you have paid out of pocket for medical expenses
Prescription Reimbursement Form	Fill out the Prescription Reimbursement Form and submit to your Pharmacy Benefit Manager (PBM) when you have paid out of pocket for prescription expenses. This form can also be used for COVID-19 OTC reimbursement requests

Ancillary Benefits

Hinge Health Detailed Program Summary	An overview of benefits offered through the Hinge Health program.
Hinge Health Chronic Pain Management Flyer	Provides information on the Hinge Health Chronic Pain Management program.
Hinge Health Women's Pelvic Health Flyer	Provides information on the Hinge Health Women's Pelvic Health program.
Hinge Health TrueMotion Guide	Provides information on Hinge Health's TrueMotion.
First Stop Health Telemedicine Flyer	An overview of your telemedicine benefits offered through First Stop Health.
Hinge Health Link	An external link to Hinge Health's website, outlining the program.
MICO Program Flyer	Provides an overview of the OptiMed MICO Program benefits effective 1/1/2026.

Machine Readable Files

Machine Readable File – America’s PPO Network	Machine Readable Files, published in accordance with the Transparency in Coverage final rule. The information contained in the files is accurate as of the “Last Updated” date and is subject to change at any time and without notice. PLEASE NOTE: Due to the amount of information contained in these files, some may be as large as one Terabyte (TB) in size. Please ensure you have the required memory capacity, hardware, and software capabilities before attempting to download. The Machine Readable Files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
Machine Readable File – Aetna Network	Machine Readable Files, published in accordance with the Transparency in Coverage final rule. The information contained in the files is accurate as of the “Last Updated” date and is subject to change at any time and without notice. PLEASE NOTE: Due to the amount of information contained in these files, some may be as large as one Terabyte (TB) in size. Please ensure you have the required memory capacity, hardware, and software capabilities before attempting to download. The Machine Readable Files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
Machine Readable File – Out of Network	Machine Readable Files, published in accordance with the Transparency in Coverage final rule. The information contained in the files is accurate as of the “Last Updated” date and is subject to change at any time and without notice. PLEASE NOTE: Due to the amount of information contained in these files, some may be as large as one Terabyte (TB) in size. Please ensure you have the required memory capacity, hardware, and software capabilities before attempting to download. The Machine Readable Files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

Coordination of Benefits

Coordination of Benefits Form	Fill out the Coordination of Benefits form and submit to HealthEZ to document any secondary insurance coverage

Member Appeal Form

Member Appeal Form	Member Appeal Form

Preventive Care Guidelines

Preventive Care Guidelines	An ounce of prevention is worth a pound of cure. That’s why your health plan fully covers preventive care services. These services are defined by the U.S. Preventive Services Task Force and vary depending on age, sex, and pregnancy. All services classified as Grade A or B are covered at no cost to you.

Precertification List

Precertification List	Common services that require precertification. For services not listed, contact the number at the top of this page for more information.

Important Notices

Paper Employee Benefit Notices	Acknowledgement of Paper Employee Benefit Notices
Notice of Electronic Disclosure	Notice of Electronic Disclosure of Employee Benefit Notices, Summary Plan Description, and Plan Amendments
CHIP Model Notice	Premium Assistance under Medicaid and the Children’s Health Insurance Program
COBRA Notice	General COBRA Notice
GINA Booklet	The Genetic Information Nondiscrimination Act
HIPAA Notice	HIPAA Privacy Notice
Newborns Act	Newborns’ and Mothers’ Health Protection Act
Special Enrollment Rights Notice	Special Enrollment Rights Notice
WHCRA	Women’s Health and Cancer Rights Ac