Plan Documents

Plan Documents

Updated 11.10.2022

Material Modification to Plans

Summary of Material Modification to Plan COVID 19 6.1.2020

Medical Plan Documents

2022 Medical & Rx Summary Plan Document 

2022 Medical & Rx Summary Plan Amendment 

2022 HDHP – Summary of Benefits Coverage

2022 HDHP – Summary of Benefits Coverage (Spanish)

2022 PPO – Summary of Benefits Coverage

2022 PPO – Summary of Benefits Coverage (Spanish)

2021 Medical & Rx Summary Plan Document

2021 Wrap Plan Document 

2021 HDHP – Summary of Benefits Coverage

2021 HDHP – Summary of Benefits Coverage  (Spanish)

2021 PPO Summary of Benefits Coverage

2021 PPO – Summary of Benefits Coverage (Spanish)

Dental Plan Documents

Delta Dental Low Plan SOB eff 07 01 18

Delta Dental High Plan SOB eff 07 01 18

2020 Dental Plan Option Summary

2020 Delta Dental Low Plan

2020 Delta Dental High Plan

2020 Vision Plan Documents

EyeMed Vision Summary of Benefits

401k Plan Documents

Mister Car Wash 401k SPD (Mercer)

Mister Car Wash 401(k) Hardship Withdrawal Amendment 

Life & Disability Plan Documents

Life Insurance Summary 7.01.2019

Short Term Disability Summary 07.01.2019

Long term Disability Summary 07.01.2019

Life Certificate of Coverage

Disability Certificate of Coverage

Required Notices

Transparency in Coverage Final Rules 

Mister Car Wash Exchange Notice 2019

Summary Annual Report 2019

Health Plan Notices 2021-2022

401(k) Summary Annual Report 2020

401(k) Summary Annual Report 2021

No Surprises Act – Balance Billing Disclosure Notice 

Mister Benefits Newsletter February 2023

Ginger Mental Health Support Will Soon Be Available for Teens

Change to Tuition Reimbursement Program in 2023

Self-Care for the Holidays

New Livongo Scale