Forms

 

• Alternate other health insurance (OHI) verification formDownload PDF
• Appeal request form and guideDownload PDF
• COBRA continuation coverage formDownload PDF
• Continuity of care request formDownload PDF
• Enrollment packetDownload PDF
• Extended eligibility applicationDownload PDF
• Life insurance beneficiary designation formDownload PDF
• Loss of time form and checklistDownload PDF
• Medical and vision claim formDownload PDF
• Non-union to union classification transferDownload PDF
• Plan 150 enrollment formDownload PDF
• Prescription refills by mail formDownload PDF
• Protected health information (PHI) release authorizationDownload PDF
• Retiree enrollment applicationDownload PDF
• Waiver of coverage for the Culinary Health Fund PlanDownload PDF