Forms and Notices
Documents Related to Health & Welfare Fund Forms
Our documents are in PDF. You may need to download the latest version of Adobe Reader.
OTC COVID-19 Tests Reimbursement Form
Coordination of Benefits (COB)
Member's Application for Benefits-Short Term Disability
Accident Details Form
Short Term Disability Continuation Form
Transition of Care Form
Health Reimbursement Form
Plan 13 Waiver Form
Plan 14 Waiver Form
Plan 16 Waiver Form
Dependent Child Certification
DavisVision Direct Reimbursement Claim Form
Coverage Medical Retiree for Debit Direct
Documents Related to Health & Welfare Fund Notices
New Health Insurance Marketplace Coverage Options and Your Health Coverage:
Questions? Contact Us!
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