PO Box 1095 Kirksville, MO 63501 cva@charitonvalley.org Phone: 660-665-1111 Fax: 660-665-1409 HR Fax: 660-665-3417

Plan Documents & Summary of Benefits

CVA Employee Benefits Packet , Summaries, Costs 2021

PPO 1500 with FSA Health Plan Summary of Benefits

PPO 2500 with FSA Health Plan Summary of Benefits

PPO 2500 High Deductible Plan with HSA Summary of Benefits

Pillpack by Amazon Cerpass RX Mail Delivery Flyer

Deltal Dental Claim Form

Delta Dental List of Providers within 15 miles 7-9-21

Delta Dental Summary Plan Description

Delta Vision Claim Form

Delta Vision Flyer

EyeMed Schedule of Benefits eff 1-11-22

Delta Vision Policy Amendment to EyeMed and Certificate

Delta Vision Notice of Privacy Practices 1-1-2022

Delta 24/7 Online Access

FSA (Flexible Spending Account) Brochure

FSA Contribution Form

HSA Contribution Direct Deposit Form

HSA Payroll Deduction Hourly Employees

HSA Payroll Deduction Exempt Employees

Self-Funded Plan Notice of Privacy Practices