Information and Forms

 Benefit Programs Administration

 1200 Wilshire Blvd, 5th Floor

 Los Angeles, CA 90017-1906

 Email:scfirefighters@bpabenefits.com

 Phone: 213-406-2370 

 Toll Free: 844-353-7839 

 Fax: 562-463-5894

Notices

• Summary of Material Modifications Discussing Trust Name Change and Benefit Increase

• Summary of Material Modifications Discussing Changes to Monthly Verification of Premiums Effective January 1, 2022

• April 2022 Investment Selection Mailing
  • Investment Selection Packet Cover Letter
  • Informational Bulletin  
  • Investment Mgr Performance Reports
  • Fee Disclosure
  • Trailing 1 -5 years and Inception To Date Performance
  • Investment Selection Form

• Conversion Election Information Packet (rev. 2019 03)
• Conversion Chart effective May 31,2013-February 29, 2016 ( conversion table 2013)
• Conversion Chart effective March 1, 2016 (conversion table 2015)
• Conversion Chart effective March 1, 2019 (conversion table 2018) 
• Conversion Chart effective March 1, 2022 (conversion table 2021)

 Forms

• Participant Data Form
• Monthly Premium Reimbursement Claim Form – To be completed for all claims effective January 1, 2022
• Medical Reimbursement Form
• Investment Selection Form

 Plan Documents

• Summary Annual Report
• Restated Plan - Effective March 1, 2021
• Amendment No. 12 to the Plan
• Summary Plan Description - Effective March 1, 2021
• COBRA General Notice 
• HIPAA Notice of Privacy Practices

 IRS Publications

• Publication 502 - Medical and Dental Expenses

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