Home

Forms

Health & Welfare Forms

• Annual Medical/Dental Update Form
• Change of Address
• Dependent Alternate Address Form
• Enrollment: Active Employee Plans (500, 551-556)
• Enrollment: Retiree Low Option Plan 520
• Enrollment: Retiree Beneficiary Election
• Enrollment: Revocation of Retiree Coverage
• Enrollment: Step/Foster Child Questionnaire
• Disability: Application for Disability
• Disability: Supplementary Disability Claim Form (Weekly)
• Prescription: Caremark Claim Form (Primary)
• Prescription: Caremark Mail Order Claim Form
• Prescription: Caremark Foreign Claim Form
• Prescription: Caremark Reimbursement Claim Form
• Notice of Privacy Practices
• Authorization for Release of Information
• Request for Confidential Communication
• Appeal Procedures

Top

Legal Forms

• Participant's Statement
• Attorney's Intake Sheet
• Retiree Legal Enrollment Form
• Legal ACH form

Top

Pension Forms

• Enrollment/Beneficiary Designation Form
• Change of Address Form
• Retirement Application and Election of Retirement Benefits
• Direct Deposit Authorization
• W-4P
• Power of Attorney Information Form

Top

Money Purchase Plan Forms

• Enrollment/Beneficiary Form
• Employee Voluntary Contribution Form
• Change of Address Form
• Power of Attorney Information Form

Top

Retiree Forms

• Certification of Retiree Signature
• Direct Deposit Authorization
• W-4P
• Voluntary Suspension of Retirement Benefit Form
• Revocation of Voluntary Suspension of Retirement Benefit Form
• Power of Attorney Information Form
• Enrollment: Retiree Low Option Plan 520
• Enrollment: Retiree Beneficiary Election
• Enrollment: Revocation of Retiree Coverage
• Retiree Legal Enrollment Form
• Retirement Application and Election of Retirement Benefits

Top

Employer Forms

• Employer Contribution Report (ECR)
• Proof of Bond

Top