User Type
Funds
Topic
Status Requests
Online Reporting (ERSS)
General Benefit Questions
UniqueFund
Health
Test
401(k)
health & welfare -active
Health & Welfare Retiree
Health & Welfare - Active
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Forms
- Address Change Form
- Beneficiary Designation Form
- Check Stub Claim Form to Report Missing Hours
- Delta Dental Claim Form
- Disability Benefit Application
- Domestic Partner Application
- Election to Terminate Domestic Partner Health Coverage
- Electronic Delivery Election Form
- Enrollment Form
- Express Scripts Reimbursement Form
- Flat Rate Subscriber Agreement
- Maternity Disability Benefit Application
- Mill Cabinet Bereavement Claim Form
- Protected Health Information Authorization
- Protected Health Information Revoke Authorization
- Reciprocity Request - Transferring Hours to Northern California
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Information about Your Plan
- Anthem Member Assistance Program (MAP) Flyer
- Anthem Member Assistance Program EOC
- Delta Dental Benefit Highlights
- Delta Dental Evidence of Coverage
- General Statement of Nondiscrimination
- Kaiser EOC Traditional HMO Flat Rate Plan (Group 9068)
- Kaiser EOC Traditional HMO Plan A (Group 26)
- Kaiser EOC Traditional HMO Plan B (Group 9076)
- Kaiser EOC Traditional HMO Plan R (Group 35684)
- Notice of Creditable Coverage
- SBC Glossary of Health Coverage & Medical Terms
- Search for Indemnity Plan Providers
- Summary of Benefits and Coverage (SBC): Plans A and R
- Summary of Benefits and Coverage (SBC): Plans B and Flat Rate
- Summary Plan Description/Rules & Regulations - Active Plans (A, B, R, Flat Rate)
- Reference
- Plan Disclosures
Health & Welfare - Retiree
-
Forms
- Address Change Form
- Delta Dental Enrollment Information (Retiree)
- Domestic Partner Application
- Election to Terminate Domestic Partner Health Coverage
- Election to Terminate Retiree Health & Welfare (Indemnity)
- Election to Terminate Retiree Health & Welfare (Kaiser)
- Electronic Delivery Election Form
- Enrollment Form
- Express Scripts Reimbursement Form
- Kaiser Senior Advantage Enrollment/Election Form
- Medicare Crossover Request
- Protected Health Information Authorization
- Protected Health Information Revoke Authorization
- Retiree Dental Termination Form
-
Information about Your Plan
- General Statement of Nondiscrimination
- Kaiser EOC Medicare Senior Advantage Flat Rate Plan (Group 9068)
- Kaiser EOC Medicare Senior Advantage Plan A (Group 26)
- Kaiser EOC Medicare Senior Advantage Plan B (Group 9076)
- Kaiser EOC Medicare Senior Advantage Plan R (Group 35684)
- Kaiser EOC Traditional HMO Non-Medicare
- Notice of Creditable Coverage
- Retiree DeltaCare HMO Evidence of Coverage
- Retiree Dental Evidence of Coverage for Retired Participants who have No Lapse in Coverage
- Retiree Dental Evidence of Coverage for Retired Participants with a Lapse in Coverage
- SBC Glossary of Health Coverage & Medical Terms
- Search for Indemnity Plan Providers
- Summary of Benefits and Coverage (SBC): Medicare
- Summary of Benefits and Coverage (SBC): Non-Medicare
- Summary Plan Description / Rules & Regulations - Retiree Plan
- Reference
- Plan Disclosures
Vacation, Holiday & Sick Leave
Pension
-
Forms
- Address Change Form
- Application for Retirement
- Beneficiary Designation Form
- California EDD Form DE-4P - Withholding Certificate for Pension or Annuity Payments
- Check Stub Claim Form to Report Missing Hours
- Community Property Estimate
- Disability Benefit Application
- Electronic Delivery Election Form
- Enrollment Form
- IRS Form W4-P - Withholding Certificate for Pension or Annuity Payments
- IRS Form W8-BEN
- Pension Direct Deposit Form
- Reciprocity Request - Transferring Hours to Northern California
- Information about Your Plan
- Reference
- Plan Disclosures
Annuity
-
Forms
- Address Change Form
- Annuity Direct Deposit Form
- Annuity Incremental Change Form
- Applications for Withdrawal
- Beneficiary Designation Form
- California EDD Form DE-4P - Withholding Certificate for Pension or Annuity Payments
- Check Stub Claim Form to Report Missing Hours
- Community Property Estimate
- Electronic Delivery Election Form
- Enrollment Form
- IRS Form W4-P - Withholding Certificate for Pension or Annuity Payments
- IRS Form W4-R - Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions
- IRS Form W8-BEN
- Reciprocity Request - Transferring Hours to Northern California
- Self-Direct Transfer Form
- Self-Direct Transfer Form - Return to Trustee-Directed
- Information about Your Plan
- Reference
- Plan Disclosures