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 Forms
Sick Fund Forms
Need to Find a Doctor, Dentist or Vision Specialist?
How do you calculate the new helper’s rate for a member under the RAB agreement?
Helpers employed by a RAB employer and new to the industry start at 70% of the current full helper rate, provided you are enrolled in the Training Fund. Helpers generally get a 5% increase every six months. Typically, helpers also get a raise on January 1 of each year, because the full helper’s rate increases then, according to the collective bargaining agreement.
You can request a rates and dues sheet. Please call the Union Office at (212) 331-1800. You can also visit the Contact Us page for more information.