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Authorization For Release of Health Information
Notice of Creditable Coverage
Premium Payment Rules For Earned and Earned Inactive Coverag
Senior Performer Or Extended Spousal Rule Sheet
Earned Premium Payment Chart
Earned Premium Auto Debit Plan Application
Senior Performers Auto Debit Plan Enrollment Form
Dental Benefits Brochure
Vision Benefits Brochure
Medical Claim Form
Delta Dental Claim Form
Delta Dental Claim Form Instructions
Medco Rx Claim Forms
Medco Home Delivery Pharmacy Service Order Form
Mental Health / Substance Abuse Treatment Claim Form
Health Insurance Claim Form
Attending Physicians Statement of Disability
Self-pay Program Summary
Self-Pay Tier FAQs
Self-pay Payment Options
Self-Pay Auto Debit Plan Application
New York State COBRA Assistance Program Application
2012 Self-pay Enrollment Form - Plan I
2012 Self-pay Enrollment Form - Plan II and 3 or More Years of Coverage - Includes Dental
2012 Self-pay Enrollment Form - Plan II and Less Than 3 Years of Coverage - Medical Only
2012 Self-pay Enrollment Form - Plan I - Loss of Dependent Status
2012 Self-pay Enrollment Form - Plan II - Loss of Dependent Status and 3 or More Years of Coverage - Includes Dental
2012 Self-pay Enrollment Form - Plan II - Loss of Dependent Status and Less Than 3 Years of Coverage - Medical Only
2012 Self-pay Enrollment Form - Plan I - Early Retirement and Disability Pensioners
2012 Self-pay Enrollment Form - Plan II - Early Retirement and Disability Pensioners
Domestic Partner Enrollment Kit Cover Letter
Domestic Partner Enrollment Q & A
California AB25 Information Sheet - Important Tax Information
Affidavit of Domestic Partnership
Affidavit of Dependency for Domestic Partnership
Statement of Domestic Partnership Disenrollment
Domestic Partner Enrollment Worksheet
Performer Information Form
Premium Rules
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Online Health Summary Plan Booklet
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Performer Information Form
Annual Summary of Earnings
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Sample QDRO
Pension Application
Performer Information Form
Designation of Beneficiary for Life Insurance
Instructions Concerning Submission of Proof of Age
50% Joint & Survivor Rejection Form
Pension Payment Election Form
Explanation of Pension Forms
Rollover Election Certification
Direct Rollover Instructions to the Trustee
Partial Lump Sum Pension Distribution
Special Tax Notice Regarding Plan Payment
QDRO/Court Order Acknowledgments
Information Concerning Other Pension Plan Benefits
IRS FORM W-4P
Pension Benefit Tax Withholding Election Form
Direct Deposit Authorization Form
Retirement Declaration and Signature Form
Acknowledgements And Certifications Form
Frequently Asked Questions
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Plan Document
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