Medical Forms Download Area

All downloads are in the Adobe Acrobat PDF format.  Viewing documents requires the Acrobat Reader that can be downloaded from the Adobe website.
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Attention all Health and Welfare participants,

HSBA, our Healthcare Administrator, will be moving this week.They are changing their name to HS&BA.
The PO Box 2300, Livermore, CA 94551 will be kept open for about 3 months, only.
Send any paper claims to HS&BA's new address:

IATSE Local #16 Health & Welfare Trust Fund
c/o HS&BA 4160 Dublin Boulevard,
Suite 400,Dublin, CA 94568-7756O

our 800# is still: 1-800-833-6696

New main number for HS&BA:  1-925-833-7300

Fax number for HS&BA: ;1-925-833-7301

Please make a note of this for your records,The staff and officers of IATSE Local 16.
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Good News regarding Stanford Hospitals !

As you are aware, Stanford University Hospital, Lucile Salter Packard Children’s Hospital and their physicians (collectively “Stanford Hospitals”) had terminated their commercial hospital and professional agreements with Anthem Blue Cross, effective September 1, 2011.  Since that time, both parties had been engaged in active negotiations.  Lucile Salter Packard Children’s Hospital rejoined Anthem’s network on 10/28/11 with a 9/1/11 effective date.

In addition, we are pleased to announce that Anthem Blue Cross has reached a multi-year agreement with Stanford University Hospital and their physicians for an effective date of 9/1/11.  Therefore there is no lapse in member coverage at Stanford Hospitals.  

Medical Claim Form  
Dental Claim Form
Vision Claim Form
Link to RXSolutions.com

RXsolutions prescription order form

Workers Compensation Medical Care Booklet
Workers Compensation Medical Care Fact Sheet
Family Medical Leave Act information video
Medical PPO directory for San Francisco Peninsula
Medical PPO directory for Easy Bay Area
Medical PPO directory for North Bay Area

  New Medical PPO directories have been released !

San Francisco Peninsula: May 2011

Easy Bay Area: Sept 2009

North Bay Area: Sept 2009

South Bay Area: Sept 2009

These are more up to date PPO directories from Anthem Blue Cross that include the participating laboratories that were left out of the last directories. 

If you want to find the most up to date list of providers, though, it’s always best to go to their Web site:  www.anthem.com/ca 

USE AND DISCLOSURE OF HEALTH INFORMATION

Very important notice regarding the Local 16 Trust's
compliance with the federal HIPAA privacy rules.
 

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We have posted these links to several videos from expert Bill Sokol on the Family & Medical Leave Act .
Mr Sokol explains what rights you are entitled to if you or immediate family member has serious illness or you have a new child.