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
- Aetna Claim Form (for claims incurred on or after 1/1/2025)
- CVS Caremark Prescription Reimbursement Claim Form (for claims incurred on or after 1/1/2025)
- OptumRx Home Delivery Order Form (for claims incurred on or before 12/31/2024)
- OptumRx Prescription Reimbursement Form (for claims incurred on or before 12/31/2024)
- Anthem Claim Form (PDF) (for claims incurred on or before 12/31/2024)
- 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 Form
Sick Fund Forms
- Sick Fund Application (PDF)
- Sick Fund Withdrawal Form (Retired or Leaving Industry Permanently (PDF)
FAQs
Why is my defaulted loan appearing on my Annuity Fund statement (and why is it increasing)?
IRS regulations require loans that are deemed to be in default to be tracked and to accumulate interest until distribution. Disclosure rules require this information to be displayed on the statement. This amount is not invested, and it is not deducted from the invested amounts at distribution. A participant may pay back the defaulted loan in full plus interest at any time, and that repaid amount will not be taxable at distribution.