Medical Plan Forms

Below you will find links to forms related to Fund medical plans.

Authorization Form

Authorization Form (PDF)

Cancellation of Authorization Form

Cancellation of Authorization Form (PDF)

Disabled Dependent Certification Form

Disabled Dependent Certification Form (PDF)

Eligible Dependent Certification Form

Eligible Dependent Certification Form (PDF)

Enrollment Form

Enrollment Form (PDF)

Medical Claim Form

Medical Claim Form (PDF)

Waiver Form

Waiver Form (PDF)