Health & Welfare
Plans
Self-funded PPO
Useful Links
Kaiser HMO Plan
Benefits
Actives
Useful Links
Retirees
Forms
- Application for Coverage as a Retiree for Health & Welfare Benefits Prefunded
- Application for Coverage as a Retiree for Health & Welfare Benefits Retiree
- Dental Claim Form
- Hartford Enrollment Form
- Health Net ENR Form
- Health Net Prescription Drug Plan Enrollment Form
- Kaiser HMO Enrollment Form
- Outpatient Rx Enrollment Form
- SSA CMS Application form L564
- United HealthCare Enrollment Form
- United HealthCare Enrollment Request Form
- United HealthCare Prescription Drug Plan Enrollment Form
Documents
- Dental PPO Plan Summary of Benefits
- GRIP II WA GRH Hartford Summary of Coverage
- Hartford IBEW Medical Benefit Chart 3777
- Hartford Summary of Coverage
- Health Net Schedule of Benefits and Coverage
- Kaiser Permanente Chiropractic Plan
- Kaiser Permanente Summary of Benefits
- United Healthcare Benefit Highlights
- Vision Benefits Summary
- VSP at your fingertips
- VSP Grievance Process Notice
Useful Links
Pension
Forms
- Address Change Form
- Beneficiary Designation Form
- California Pension Withholding Form
- Electronic Funds Transfer Form (Parts A & B)
- Federal Pension Withholding Form
- Health & Welfare Withholding Form
- Pre-Retirement Death Benefits (Part B Only)
- Pre-Retirement Death Benefits (Parts A & B)
- Qualified Domestic Relations Order Sample (Active Member)
- Qualified Domestic Relations Order Sample (Retired Member)
Defined Benefit
Defined Contribution & 401K Plan
Forms
- Application For A Plan Loan
- Disability Application
- Distribution/Rollover Election Form
- Fillable Master Beneficiary Card
- Mandatory Payment of Small Account Balances
- Pre Retirement Death Request for Part B
- Request for Part B Application
- Request for Pension Part A Application
- Special COVID-19 Open Enrollment
- Special COVID-19 Open Enrollment Letter