Find and download different forms relating to Local 94 and its affiliated Benefit Funds.
Local 94 Forms
Annuity Fund Forms
- For all Annuity Fund Forms, such as a distribution request, loan application or beneficiary form, please visit the mylife.jhrps.com. website.
Health and Benefit Trust Fund Forms
- OptumRx Home Delivery Order Form
- OptumRx Prescription Reimbursement Form
- Empire Claim Form (PDF)
- Sele-Dent Claim Form (PDF)
- Coordination of Benefits Form (PDF)
- Beneficiary Designation Form (PDF)
- Commercial Loss of Time Claim Form (PDF)
- School Loss of Time Claim Form (PDF)
- Authorization to Release PHI Form (PDF)
- Commercial In-House Claim Form (PDF)
- School Retiree Medicare Related Premium Reimbursement Form
- School In-House Claim Form (PDF)
- For all Pension forms, such as beneficiary, direct deposit, and retirement application forms please visit the Central Pension Fund website.
Scholarship Fund Forms
Sick Fund Forms
Need to Find a Doctor, Dentist or Vision Specialist?
How do I add my newborn child to my plan?
You must provide the Fund Office with a copy of the child’s birth certificate within 90 days of birth to enroll your child with the applicable date (child’s birthdate). If you fail to do so, within the applicable 90-day period, dependent coverage will not be available under the Plan for your new dependent child until the first of the month following the date in which you provide the Fund Office with the required documentation or any other verifying information requested. A Coordination of Benefits Form (COB) must be completed if your child has other coverage. You should also visit the Life Events page on this site to see what you need to do for your other benefits.