Beneficiary Form
Change of Address
General Authorization Cancellation Form
General Authorization Form
Summary Plan Description - 2025
Fitness Your Way Program
Glosario de terminos medicos y seguros de salud - 2021
Summary of Benefits & Coverage 2026
Glossary of Health Coverage & Medical Terms - 2021
VSP Grievance Process and Timely Access to Care Notice
Your Rights And Protections Against Surprise Medical Bills
VSP Member Benefits Summary
MetLife PPO Benefits Summary (Effective October 1, 2023)
DeltaCare USA DHMO Benefits Summary
Notice of Privacy Practices
Annual Medicare Part D Notice
HRA Benefits Mobile App Guide
HRA Benefits Portal Guide
Telemedicine Programs
Overview for New Participants
HW Supplement No. 1 Colonoscopy Screening
HW Supplement No. 2 HRA forfeiture provision changes
HW Supplement No. 3 Vacation Holiday Sick Pay
HW Supplement No. 4 - Specialty Medication Step Therapy
HRA Reimbursement Form
Enrollment Form
Disenrollment Form
Weekly Disability Benefits Notice of End of Disability Form
Weekly Disability Benefits Application Form
Dental Enrollment Form (During Open Enrollment only)
Dental Enrollment Form (For those who have not yet made an election)
Prescription Drug Claim Form
Vision Enrollment Form (For those who have not yet made an election)
Injury and Third Party Liability Form
Annual Coordination of Benefits Form
PHI Request Form
Weekly Disability Continuation Form
VSP Grievance Process And Timely Access To Care Notice
DeltaCare USA High Benefit Summary
DeltaCare USA Medium Benefit Summary
MetLife PPO Benefit Summary
PSS Supplement No 2 - Colonoscopy Screening
PSS Supplement No. 3 - Medicare part D
PSS Supplement No. 4 - Specialty Medication Step Therapy
Annual Statement of Employment by Pensioner (Over Age 70 ½)
Surviving Spouse Medical Dental & Vision Enrollment Form
Vision Enrollment Form (During Open Enrollment Only)
Dental Enrollment Form (During Open Enrollment Only)
Supplement #1 - Nov 2019 (Change in How Fees will be Charged)
Supplement #2 - Jun 2020 (Hardship Distribution for FEMA Declared Disasters and Suspension of Minimum Required Distributions for 2020)
Supplement #3 - Sept 2020 (Distribution for the Birth or Adoption of a Child)
Supplement #4 - Oct 2020 (Distributions Transfers Change in Status)
Supplement #5 - Feb 2022 (Claims Processing Timeline)
Supplement #6 - Jan 2023 (Reduction in Fees)
Supplement #7 - June 2024 (Required Beginning Distributions, Involuntary Cash-Out of Small Accounts, Distributions to Terminally Ill Participants, and Disclaimer of Benefits)
Supplement #8 - August 2024 (Increase in Fees Charged to Accounts to Cover Plan Expenses)
Supplement #9 - March 2025 (Qualified Disaster Recovery Distributions)
Certification of Termination of Employment
Payment Due to QDRO Application
Termination Distribution Application
Qualified Birth Adoption Withdrawal
DC Fund Enrollment/Change/Opt Out Form
Retirement/Disability Distribution Application
Retirement Declaration Form
Termination Distribution for Non-Covered Employment
Home Repair Option Supplemental Form
Fund Rollover Notice
Special Employer Account 401(a) Withdrawal Application
Hardship Withdrawal Application
Evidence Required For Hardship Withdrawals
Terminal Illness Withdrawal Application
Death Benefit Application
Certification of Termination of Non-Covered Employment
Qualified Disaster Recovery Distribution Application
Termination Distribution for Landscape DCPP Only PreMerger 401a Funds
Loss of Income Verification
Supplement #1 - Jun 2020 (Merger of the Vacation & Holiday into the Health & Welfare Fund)
Interim Withdrawal Form
V&H Monthly Benefit Election Direct Deposit Form
V&H Normal Benefit Election Direct Deposit Form
Supplement #1 - Nov 2019 (Modification in Suspension of Benefits Age 65 or Older)
Supplement #2 - Jul 2020 (Changes in Contribution Rates)
Supplement #3 - May 2021 (Pension Benefit Accrual Rate Increase)
Supplement #4 - Sept 2022 (Pension Benefit Increase)
Supplement #5 - Dec 2022 (Proof of Total Disability)
Supplement #6 - Dec 2024 (Modification of the Post-Retirement Civil Service Employment Rule for Pensioners under Age 70½)
Supplement #7 - Modification to the Required Beginning Date for Plan Participants
Tax Notice 2024
Annual Funding Notice 2020
Annual Funding Notice 2021
Annual Funding Notice 2022
Annual Funding Notice 2023
Annual Funding Notice 2024
Annual Funding Notice 2025
Annual Statement by Pensioner (Under 65)
Annual Statement by Pensioner (Ages 65-70½)
Basic Pension Application
Direct Deposit Form
Federal Income Tax Withholding Form
Alternate Payee Application for Benefits
State Tax Withholding Form
401(K) Form Revision Notice to Employers
401(k) Contribution Limit Changes for 2025
Contribution Payment Methods
Managing Contribution Benefits
401(k) Enrollment/Change/Opt-Out Form
Change of Address Form
Corporate Officer Sole Proprietor Election to Participate
Designation of Exempt Owner
Inactive Status Request Form
Benefit information varies by Trust Funds. Please make a selection.
