Health Fund Forms | Transportation Communications International Union - Los Angeles Metropolitan Authority Health & Welfare Trust Fund

Forms

Dental Claim Form

Dental Plan Enrollment Form

Employee Deduction Authorization Form

Domestic Partner Enrollment Form

Kaiser Enrollment Form

Prudential Life Insurance Beneficiary Designation Form

Medical Claim Form

Medical Plan Enrollment Form

Member Assistance Program

United Health Care Enrollment Form

TCU OPT-OUT Provisions

United Concordia Dental Plan Enrollment Form

Extra Mile Benefits (Wellness Plan)

VSP Vision Enrollment Form

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Disclaimer: Health benefits are available only if your employer participates in the Health Benefit Fund by paying the proper contributions. If you are in doubt as to whether contributions are being made on your behalf, check with your employer or the Administrative Office.