Benefits Online Forms

In order to save our members time, we are pleased to offer our most requested forms online. All forms should be filled out completely and mailed to the

     PBA Funds Office
     125 Broad Street
     11th Floor
     New York, NY 10004-2400

pencilAnnuity Plan Beneficiary Designation
pencilCaremark Prescription Drug Claim
pencilCatastrophic Benefit Claim (Active members only)
pencilChange of Address
pencilDental Claim
pencilDependent Life Insurance Enrollment
pencilDependent Student Certification (Retirees only)
pencilEnrollment (Active members only)
pencilEnrollment (Retirees only)
pencilHearing Aid
pencilHIPAA Authorization
pencilLife Insurance Beneficiary Designation
pencilMedical Equipment Benefit
pencilOptical Benefit - Direct Reimbursement Claim Form
pencilReimbursement for Real Estate Legal Services