Participant Information Form

Update your contact information with the Plan. You can also update your information by logging in to your Benefits Manager

Dependent Information Form

Update Dependent contact information with the Plan. Dependent information can also be updated by logging in to the Benefits Manager

New Dependent Form

Add new dependents for health coverage during open enrollment or following a life event. You can also add dependents by logging in to your Benefits Manager

Designation of Beneficiaries Form

Use this form to designate the beneficiaries of your Plan benefits in the event of your death.

Authorization for Release of Health Information Form

Give us permission to disclose your health information to a specific person or organization.

HRA Enrollment Waiver

Senior Performers should use this form if they have health coverage through Medicaid, Medi-Cal, military (TRICARE, VA), another retirement plan or are ineligible for Medicare due to residency requirements. When submitting the form, please attach the required documentation.