Update your contact information

You can also update your information by logging in to your Benefits Manager. All Health Plan documents that are completed can be emailed to [email protected].

• Participant Information Form
• Dependent Information Form
• New Dependent Form

Designation of Beneficiaries Form

Use this form to designate the beneficiaries of your Plan benefits in the event of your death.

Authorization for Release of Health Information Form

Give us permission to disclose your health information to a specific person or organization.

HRA Enrollment Waiver

Senior Performers should use this form if they have health coverage through Medicaid, Medi-Cal, military (TRICARE, VA), another retirement plan or are ineligible for Medicare due to residency requirements. When submitting the form, please attach the required documentation.