HEALTH & WELFARE

Forms

Enrollment

Enrollment/Beneficiary Form

Forms

Accident Letter

Age 65 Continuation of Health Election Form

Beneficiary Designation

Change of Address Form

COB Letter

Dental Claim Form

Medical Claim Form

Prescription Drug Claim Form - OptumRx

Proof of Death Claim Form - Mutual of Omaha 

Reimbursement Agreement – AK UFCW

Vision – VSP – Out-Of-Network Reimbursement Form