Forms and Documents
You can download and complete the forms available through this website; you will need to submit them through the secure JBT member portal.
Change Your Address
Enrollment Forms
Full-Time Health Benefits
Enrollment Form for Full-Time Health Benefits Plan Employees (English)
Enrollment Form for Full-Time Health Benefits Plan Empolyees (Spanish)
Kaiser HMO Enrollment Form
Olam Enrollment Form for Full-Time Health Benefits Plan Employees (English)
Olam Enrollment Form for Full-Time Health Benefits Plan Employees (Spanish)
Seasonal Medical Benefits
Enrollment Form for Seasonal Medical Benefits (English)
Enrollment Form for Seasonal Medical Benefits (Spanish)
Olam Seasonal Medical Benefits Enrollment Form (English)
Olam Seasonal Medical Benefits Enrollment Form (Spanish)
Seasonal Benefits
Enrollment Form for Seasonal Benefits (English)
Enrollment Form for Seasonal Benefits (Spanish)
Summary Plan Description (SPD)
Full-Time Health Benefits
(annual minimum work hours required)
Full-Time Health Benefits Summary Plan Description: coming soon
June 2023 Summary of Material Modifications (English)
June 2023 Summary of Material Modifications (Spanish)
April 2023 Summary of Material Modifications (English)
Seasonal Medical Benefits
(pre 7/1/2003 three-year seniority)
Seasonal Medical Benefits Summary Plan Description (English)
Seasonal Medical Benefits Summary Plan Description (Spanish)
April 2023 Summary of Material Modifications (English)
July 12, 2022 Summary of Material Modifications (English)
July 12, 2022 Summary of Material Modifications (Spanish)
Seasonal Benefits
Seasonal Benefits Summary Plan Description: coming soon
Medical
Full-Time Health Benefits
(annual minimum work hours required)
Full-Time Health Benefits Plan Summary of Benefits and Coverage
Full-Time Health Benefits Plan Kaiser HMO Summary of Benefits and Coverage
Full-Time Health Benefits Plan Medical and Prescription Drug Benefits Comparison Chart
Seasonal Medical Benefits
(pre 7/1/2003 three-year seniority)
Seasonal Medical Benefits Plan Summary of Benefits and Coverage
Seasonal Medical Benefits Plan Medical and Prescription Drug Benefits Comparsion Chart
Hip and Knee Hospitals / Mammogram Providers
Dental
Vision
Full-Time Health Benefits
(annual minimum work hours required)
Vision Benefit Summary – 1400 Hour Participants (English)
Vision Benefit Summary – 1400 Hour Participants (Spanish)
Seasonal Medical Benefits
(pre 7/1/2003 three-year seniority)
Vision Benefit Summary – Non-1400 Hour Participants (English)
Vision Benefit Summary – Non-1400 Hour Participants (Spanish)
Seasonal Benefits
Vision Benefit Summary – New Entrants (English)
Vision Benefit Summary – New Entrants (Spanish)
Additional Documents
Authorization to Use and/or Disclose Personal Health Plan Information (English)
Authorization to Use and/or Disclose Personal Health Plan Information (Spanish)
Notice of Privacy Practices (English)
Notice of Privacy Practices (Spanish)
Surprise Billing Notice (English)
Surprise Billing Notice (Spanish)
Women’s Health and Cancer Rights Act Notice (English)
Women’s Health and Cancer Rights Act Notice (Spanish)