FUND OFFICE RELATED FORMS AND DOCUMENTS

Aetna Enrollment Form (pdf)

Individual Account Claim (IAP) Form (pdf)

AETNA RX Home Delivery Medication Order Form (pdf)

IAP Claim Workbook (Helps you to calculate & organize your receipts (xlsx)

Supplemental Disability Allocation Form (pdf)

Appeals of Adverse Determination (pdf)

Coordination of Benefits Questionnaire (pdf)

SPOUSE INSURANCE INFORMATION REQUEST FORM (pdf)

Spousal Insurance Option Election-Rejection Form (pdf)

Adult Dependent Enrollment Certification Form (pdf)

Dependent Child Coordination of Benefits Form (pdf)

Personal Representative Authorization (pdf)

Notice of Privacy Policy (pdf)

Dental & Vision Benefits Termination (pdf)

Electronic Transfer Authorization 2021 (pdf)

Designation Beneficiary Forms Plus Instructions (pdf)

Pension Verification Update Letter (pdf)

Health Accident Fund Summary Plan Description (pdf)

Pension Fund Summary Plan Description (pdf)

Annuity Fund Summary Plan Description (pdf)

Summary of Health Benefits & Coverage (pdf)