Below is a list of downloadable forms for our members’ convenience.
RELIEF FORMS
NOTE: Forms must be downloaded and completed on your desktop.
Designation of Beneficiary ONLINE
Update Form ONLINE
MEDICAL FORMS
Disabled Dependent Certification
Medical Claim Form and Authorization (aka Green Form)
Medical Plan Enrollment / Change Form
FAX NUMBERS
- Add/Drop Dependent (323) 259-5297
- Flu Vaccine Claim Form (559) 499-2464 or (323) 259-5295
- Green Form / Unprocessed Medical Expenses Claim Form (CA) (559) 499-2464 or (323) 259-5295