Resources

Plan Documents

• Summary Plan Description
• Affordable Care Act
• Affordable Care Act Reporting

Forms

• Address Change Form
• Local 467 Medical Enrollment or Change Form
• Kaiser Medical Enrollment or Change Form
• Kaiser Medical Enrollment or Change Form (Spanish)
• Kaiser Senior Advantage Enrollment Form (Retirees 65+)
• Navia HRA Reimbursement Claim Form
• Navitus Prescription Reimbursement Claim Form

Substance Abuse Care

BeatIt! provides substance abuse services for Anthem PPO medical plan participants. Kaiser provides mental health and chemical dependency services for its members.

• Beat It! Employee Assistance
• Beat It! Flyer
• Beat it! website or call  (800) 828-3939

Dental Care

• Dental Benefits
• Delta Dental Benefits Summary (79-02002, Residential)
• Delta Dental Benefits for Dependent Children Summary (79-02001, Non-residential dependent children)
• Delta Dental Enrollment Form
• Delta Dental PPO Flyer
• Delta Dental TMJ Flyer

Forms

Before you retire:

• Defined Contribution Loan Application
• Beneficiary Designation

Retirement application:

• Defined Contribution Application
• Defined Benefit Application

Making changes after you are retired:

• Defined Contribution Distribution Forms
• Address Change
• Electronic Deposit (EFT for pension payments)
• Beneficiary Designation

Tax form links:

• Tax Withholding, Federal (IRS website)
• Tax Withholding, State (CA EDD website)
• Tax Withholding, State (Spanish) (CA EDD website)