Forms
Find and download different forms relating to Local 94 and its affiliated Benefit Funds.
Local 94 Forms
Annuity Fund Forms
- For all Annuity Fund Forms, such as a distribution request, loan application or beneficiary form, please visit the mylife.jhrps.com. website.
Health and Benefit Trust Fund Forms
- OptumRx Home Delivery Order Form
- OptumRx Prescription Reimbursement Form
- Empire Claim Form (PDF)
- Sele-Dent Claim Form (PDF)
- Coordination of Benefits Form (PDF)
- Beneficiary Designation Form (PDF)
- Commercial Loss of Time Claim Form (PDF)
- School Loss of Time Claim Form (PDF)
- Authorization to Release PHI Form (PDF)
- Commercial In-House Claim Form (PDF)
- School Retiree Medicare Related Premium Reimbursement Form
- School In-House Claim Form (PDF)
Pension Forms
- For all Pension forms, such as beneficiary, direct deposit, and retirement application forms please visit the Central Pension Fund website.
Scholarship Fund Forms
- Scholarship Fund Application (PDF)
- Journal Ad Contract (PDF)
Sick Fund Forms
FAQs
I am getting a divorce. What do I need to do in terms of my pension?
You must provide the Central Pension Fund with a copy of the entire divorce decree. We recommend that you also visit the Central Pension Fund website for information about Qualified Domestic Relations Orders (QDROs) and visit the Life Events page on this site to see what you need to do for your other benefits.