|Note: Adobe Acrobat Reader is required to view and print all downloadable forms. You can download the free Adobe Acrobat Reader by clicking on this link.
2018 Coordination of Spouse Employer Cover Letter - Cover Letter for Coordination of Spouse Benefit Form.
2018 Coordination of Spouse Employer Form - Form to be submitted for verification of spouse's benefits.
2018 Dependent Age 19 - 26 Cover Letter - Cover Letter for Dependent to Age 26 Enrollment Form.
2018 Dependent Age 19 - 26 Form - Form to be submitted for verification of dependent enrollment.
Change of Address- Form to notify the Fund office if you change your mailing address.
Enrollment Form - Form for enrolling for benefits.
Enrollment Form for Municipalities - Form for enrolling for benefits. This is for Municipal Employees Only.
Enrollment Form Instructions - Form for enrolling for benefits. This is for Municipal Employees Only.
HIPAA Privacy Notice - Notice regarding the Health Insurance Portability and Accountability Act 0f 1996.
HIPAA Authorization Form - Form to release personal information to a third party.
Rx Reimbursement - COB Claim Form - Form for Prescription COB Claim Reimbursement.
Mail Order Rx Fax Back Form from Provider - Form for Prescription Fax Back from Provider.
Home Delivery Rx Order Form - Form for Mail Order Home Delivery Prescriptions.