Find forms & documents Benefit Document Library
Welcome to the document library for the UNITE HERE Local 11 Health Benefit Fund. Here you’ll find up-to-date documents, notices and resources regarding your benefits.
- General Forms & Documents
- MLK Care Medical Plan
- Health Net Medical Plan
- Kaiser Permanente Medical Plan
- Older Notices
General Forms & Documents
The following documents and resources are for all participants, regardless of medical or dental plan. Download a copy of the SPD, compare medical plans, and find resources for managing your benefits on our secure member portal.
Summary Plan Description - English
This is your benefits booklet known as the Summary Plan Description of the MLK Care Medical Plan.
Summary Plan Description - Spanish
This is your benefits booklet known as the Summary Plan Description of the MLK Care Medical Plan.
Benefit Summary Comparison – English
Compare medical and dental plan options, and see what you pay for prescriptions, vision, life insurance and employee assistance program in English.
Benefit Summary Comparison – Spanish
Compare medical and dental plan options, and see what you pay for prescriptions, vision, life insurance and employee assistance program in Spanish.
July 2025 SMM – Administrative Improvements – English
Notice announcing new Benefit Administrative Office, new member services team, and Fund name change.
July 2025 SMM – Administrative Improvements – Spanish
Notice announcing new Benefit Administrative Office, new member services team, and Fund name change in Spanish.
June 2025 SMM – Health Plan Changes – English
Notice announcing health plan changes including better coverage.
June 2025 SMM – Health Plan Changes – Spanish
Notice announcing health plan changes including better coverage in Spanish.
April 2025 SMM – New Dental Office – English
Notice announcing new dental office and UNITE HERE Health Center in English.
April 2025 SMM – New Dental Office – Spanish
Notice announcing new dental office and UNITE HERE Health Center in Spanish.
Enrollment Instructions - English
Step-by-step instructions on how to enroll for benefits on our secure portal.
Enrollment Video Instructions - English
A guided video on how to enroll for benefits on our secure member portal.
Express Scripts Home Delivery Form
Sign up for home delivery for maintenance medications.
Express Scripts Claim Form
Sign up for home delivery for maintenance medications.
COBRA Election Enrollment
Visit to learn more about continuation of coverage under COBRA.
COVID At-Home Test Claim Form
Complete to get reimbursed for COVID-19 at-home tests.
Employee Disability Credit Form
If you (Patient) will be unable to return to work immediately as a result of a current or recent disability, this form must be completed by the attending physician and returned. You may submit a disability credit form after you have had your maximum FMLA leave, or if you do not qualify for FMLA.
MLK Care Medical Plan
Summary Plan Description
This is your benefits booklet known as the Summary Plan Description of the MLK Care Medical Plan.
Summary Plan Description - Spanish
This is your benefits booklet known as the Summary Plan Description of the MLK Care Medical Plan.
MLK Care Summary of Benefits and Coverage (SBC) - English
MLK Care Summary of Benefits and Coverage (SBC) - Spanish
Learn what this plan covers and what you pay for covered services.
Carelon Employee Assistance Program EOC
Evidence of Coverage explaining what is covered.
MLK Community Medical Group Flyer
Learn about services and locations in English and Spanish.
UNITE HERE Dental Office Flyer
Information about the UNITE HERE Health Center in English and Spanish.
Carelon Flyer
Information about the Member Assistance Program (MAP) provided through Carelon in English and Spanish.
Hinge Health Flyer
Virtual physical therapy with no co-pays and no office visits.
Health Net Medical Plan
Summary Plan Description
This is your benefits booklet known as the Summary Plan Description for the Health Net Plan.
Summary Plan Description - Spanish
This is your benefits booklet known as the Summary Plan Description of the MLK Care Medical Plan.
Health Net Summary of Benefits Coverage (SBC) – English
Health Net Summary of Benefits Coverage (SBC) - Spanish
Learn what this plan covers and what you pay for covered services.
Kaiser Permanente Medical Plan
Summary Plan Description
This is your benefits booklet known as the Summary Plan Description for the Kaiser Permanente Plan.
Summary Plan Description - Spanish
This is your benefits booklet known as the Summary Plan Description of the MLK Care Medical Plan.
Kaiser Summary of Benefits Coverage (SBC) – English
Learn what this plan covers and what you pay for covered services.
Kaiser Summary of Benefits Coverage (SBC) - Spanish
Learn what this plan covers and what you pay for covered services.
Virtual Care Options
Skip a trip to the doctor’s office with Kaiser’s virtual care options.
Older notices
Don’t see what you are looking for?
Contact the Benefit Administrative Office at (866) 345-5189, leave your name and phone number, and a representative will call you back.