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)
- For all Pension forms, such as beneficiary, direct deposit, and retirement application forms please visit the Central Pension Fund website.
Scholarship Fund Form
Sick Fund Forms
Need to Find a Doctor, Dentist or Vision Specialist?
Why did I receive a bill for medical services?
While the Plan offers medical, prescription drug, dental and vision coverage, it does not pay 100% for all of these services. There are co-payments and coinsurance that you or your covered dependents may be responsible for paying. For more information about your benefits, please visit the Health and Benefit Trust Fund section of this site.