1199SEIU Family of Funds. Caring for Those who Care for Others.
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Forms: For Members
Summary Plan Descriptions
Forms: For Providers
Forms: For Employers
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Forms: For Members
General
Healthcare and Other Benefits
Pension & Retirement
Child Care & Youth Programs
General
Change of Address - Active Members
Change of Address - Retirees
Healthcare and Other Benefits
National Benefit Fund
Accidental or Occupational Disease Compensation Report
Authorization for Release of Protected Health Information
Disability Claim Form
Benefits and Pension Enrollment Form
Employer's Disability Statement
Enrollment Change Form
Hearing Aid Form
Home Oxygen Therapy Request for Authorization
Mail Order Prescription Form
Medical Reimbursement Claim Form
Medicare Part B Reimbursement Form
Medical Proof of Change in Condition in Support of Application for Reopening Claim
Member Choice Enrollment Form
Prescription Reimbursement Form (Primary, COB, Foreign)
Prescription Request for Authorization
PT/OT/ST Benefit Extension Request Form
Service/Equipment Request for Authorization
Supplemental Medical Information-OBGYN
Supplemental Medical Information-Physical Medicine and Rehabilitation
State of New York Workers' Compensation- Claimant's Request for Further Action
State of New York Workers Compensation - Employees Claim for Compensation
State of New York Workers' Compensation - Medical Proof of Change in Condition
State of New York Worker's Compensation- Attending Doctor's Report
Greater NY
Authorization for Release of Protected Health Information
Benefits and Pension Enrollment Form
Enrollment Change Form
Member Choice Enrollment Form
Home Care Benefit Fund
Authorization for Release of Protected Health Information
Benefits and Pension Enrollment Form
Enrollment Change Form
Home Health Aide Benefit Fund
Authorization for Release of Protected Health Information
Pension & Retirement
Health Care Employees Pension Fund
Application for Early or Normal Pension
Application for Pension Disability Benefit
Direct Deposit Form
Hospital Inquiry Form
Pension Beneficiary Option Form
Greater NY
Application for Early or Normal Pension
Pension Beneficiary Option Form
Direct Deposit Form
Home Care
Beneficiary Form for Single Working Members
Direct Deposit Form
Home Care Agency Inquiry Form
Parent Guardian Affidavit Form
Application for Early or Normal Pension
Proof of Age Form
Spouse Affidavit Form
Home Care Request for Pension Estimate Form
Home Care Pension Beneficiary Payment Option
Child Care & Youth Programs
Camp Applications
Camp Application- English
Camp Application- Spanish