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
How can I get a Scholarship Fund application?
You can download a Scholarship Fund Application by visiting the Participating in the Scholarship Fund page here. Go to the Scholarship Fund page for application and eligibility rules.