Health & Welfare Forms
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- Accidental Injury Questionnaire
- Affidavit Declaring Marital Status
- Application for Member Death Benefit
- Flex Benefit Account Reimbursement Request Form
- Loss of Time and Attending Physician's Statements
- Loss of Time Direct Deposit Authorization Agreement
- Participant Data and Beneficiary Form
- Retiree Direct Debit Authorization Agreement
- Retiree SUB Fund Self-Payment Election
- Self-Payment Minimum Coverage Election
- Spousal Other Insurance Reimbursement Form
- Yearly coordination of Benefits and Dependent Status