Benefits Forms

• Annuity Plan Beneficiary Designation
• Caremark Prescription Drug Claim. Important: Caremark prescription drug claim form has changed: Your prescribing physician's information is now required. See Step 2 of the new form for updated submission requirements.
• Catastrophic Benefit Claim (Active members only)
• Change of Address
• Dental Claim
• Out-of-Network Dental Schedule for 2020
• Dependent Life Insurance Enrollment
• Enrollment (Active members only)
• Enrollment (Retirees only)
• Hearing Aid
• HIPAA Authorization
• Life Insurance Beneficiary Designation
• Medical Equipment Benefit
• Medicare Part B Reimbursement Differential Request Form 2019
• Vision Benefit - Direct Reimbursement Claim Form
• Reimbursement for Real Estate Legal Services

Benefits Forms

• Annuity Plan Beneficiary Designation
• Caremark Prescription Drug Claim. Important: Caremark prescription drug claim form has changed: Your prescribing physician's information is now required. See Step 2 of the new form for updated submission requirements.
• Catastrophic Benefit Claim (Active members only)
• Change of Address
• Dental Claim
• Out-of-Network Dental Schedule for 2020
• Dependent Life Insurance Enrollment
• Enrollment (Active members only)
• Enrollment (Retirees only)
• Hearing Aid
• HIPAA Authorization
• Life Insurance Beneficiary Designation
• Medical Equipment Benefit
• Medicare Part B Reimbursement Differential Request Form 2019
• Vision Benefit - Direct Reimbursement Claim Form
• Reimbursement for Real Estate Legal Services