Form Library – Brady Trucking Benefits

Form Library

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 1-866-768-9685

2025 Medical Benefit Information

Benefit Overview	Provides a high level overview of your HealthEZ medical benefits.
HSA Plan SBC	Provides an easy-to-understand summary about a health plan’s benefits and coverage.
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.
Diabetes Supply Program	This form provides information about the HealthEZ Diabetes program.
Preventive Services	Provides a high level overview of your preventive services.
LivEZ Smoking Cessation	Quitting tobacco is hard, but we’re here to help!
HealthiestYou	Provides a high level overview of the healthiestyou program

Ancillary Benefits

Drivers Benefit Summary	Provides a high level overview of your dental, vision, disability benefits and life insurance. As well as information on discounts, services and benefit resources for drivers.
Other Members Benefit Summary	Provides a high level overview of your dental, vision, disability benefits and life insurance. As well as information on discounts, services and benefit resources.
Dental Benefits Summary	Provides a high level overview of your dental benefits.
Vision Benefit Summary	Provides a high level overview of your vision benefits.
Life Insurance Benefit Summary	Provides a high level overview of your life insurance benefits.
Disability Benefit Summary	Provides a high level overview of your short term disability benefits.
Group Term Life Benefit Summary	Provides a high level overview of the Group Term Life coverage available from Principal Life Insurance Company.
Voluntary Term Life Benefit Summary	Provides a high level overview of the key benefits of the life coverage available from Principal Life Insurance Company.

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.

Pharmacy Benefit Information

Magellan Portal Login	This guide provides step-by-step directions on using your MagellanRx secure member portal.
Mail Service FAQ	This guide provides information on ordering your medication by mail.
Mail Service Order Form	Mail Service Order Form
National Chain Pharmacy Listing	This is a list of the national chain pharmacies that participate in the Magellan Rx Management commercial pharmacy network.
Preventive Drug List	This is a list of preventive medications covered at no cost under the Patient Protection and Affordable Care Act (PPACA).
Generics	Save money by choosing quality, cost-effective alternatives to brand medications
Medication Adherence	This guide provides information on promoting healthier outcomes and reducing medical complications.
Magellan Formulary	This guide provides the most up-to-date Formulary Drug list

Machine Readable File

Machine Readable File – Cigna 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 - Wise 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.

Preventive and Wellness Services

Preventive and Wellness Services	Provides information on your common preventive and wellness services.

Precertification

Precertification List	Provides a general overview of common services that require precertification. For specifics, please contact the number at the top of this page.

Coordination of Benefits

Coordination of Benefits (COB) Letter	A Coordination of Benefits (COB) letter is sometimes needed to process claims if you are covered by more than one health plan. It clarifies who pays what by determining which plan is the primary payer and which is secondary. Members will be notified if this form is required.

Appeal Forms

Member Appeal Form	Complete this form when you want to request a review of a denied claim, coverage decision, or adverse benefit determination.

Important Notices

Your Rights and Protections Against Surprise Medical Bills	When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
Notice of Electronic Disclosure	Notice of Electronic Disclosure of Employee Benefit Notices, Summary Plan Description and Plan Amendments
Paper Employee Notices	Acknowledgement of Paper Employee Benefit Notices
Children's Health Insurance Program (CHIP) Notice	Explains how your eligibility for Medicaid or CHIP may qualify you for premium assistance to pay for your employer's health coverage
COBRA Notice	Explains your right to continue health benefits, if you were to lose them through your group health plan.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) Notice	Explains how personal health information about you may be used and disclosed.
Newborn Act Notice	Explains how important protections for your members and their newborn children.
Special Enrollment Notice	Explains your right to enroll in your group health plan, if you lose your "other" health coverage.
The Genetic Information Nondiscrimination Act (GINA) Booklet	Explains how discrimination on genetic information is prohibited in group health plan coverage
Women's Health and Cancer Rights Act of 1998	Explains important protections for those who choose to have breast reconstruction, in connection with a mastectomy.
HealthEZ Privacy Policy	A summary of key provisions of our Privacy Notice.