Forms and Documents
Disability Income Benefits Authorization for Release of PHI
Disability Income Benefits Claim Form
Application for Retiree Benefits
Anthem SBC for Compliant HEP Participants
Anthem SBC for Non-Compliant HEP Participants
Extended Benefit Fund Summary Plan Description
Over-the-Counter COVID-19 Test Information
Tri-State EAP - Mental Health Crisis Flyer
Extended Benefit Fund and Annuity Fund Summary Annual Report
Dental, Weekly Disability, Ground Ambulance Services Benefits SMM - Actives - 2024
Dental, Weekly Disability, Ground Ambulance Services Benefits SMM - Actives - 2024 (1)
Ground Ambulance Services SMM - Retirees- 2024.pdf
Active Member Weekly Disability Benefit Time Limit Change SMM (October 2024)
CTW-4P Withholding Certificate for Pension or Annuity Funds
W-4P Withholding Certificate for Pension or Annuity Funds
Direct Deposit Authorization Form
Notice of Critical Status October 2022
Pension Plan Annual Funding Notice 2022
Pension Plan Notice of Critical Status 2023
Notice of Critical Status (October 2024)