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
What is the Family and Medical Leave Act (FMLA)?
Generally, the Family and Medical Leave Act (“FMLA”) allows you to take up to 12 weeks of unpaid leave during any 12-month period due to:
- the birth, adoption, or placement with you for adoption of a child;
- to provide care for a spouse, child, or parent who is seriously ill; or
- your own serious illness.
You are generally eligible for a leave under the FMLA if you:
- have worked for the same Contributing Employer for at least 12 months;
- have worked at least 1,250 hours over the previous 12 months; and
- work at a location where at least 50 employees are employed by the Contributing Employer within 75 miles.
If you would like more information in regards to this please visit the FMLA section of the DOL website or contact your Business Representative.