Resources
Health and Welfare
Plan Documents
Forms
- Address Change Form
- Anthem Self-funded PPO Reimbursement Claim Form
- Disability Form (Permanent)
- Disability Form (Short Term)
- Healthcare Enrollment or Change Form (Actives)
- Healthcare Enrollment Form (Retirees)
- HIPPA Authorization
- HRA Reimbursement Claim Form
- HRA Reimbursement Claim Form (Spanish)
- Kaiser Medical Enrollment or Change Form
- Kaiser Medical Enrollment or Change Form (Spanish)
- Kaiser Senior Advantage Enrollment Form (Retirees 65+)
- Life Insurance Beneficiary Form
- Life Insurance Claim Form
- Marriage Confirmation (requires notary) – English
- Marriage Confirmation (requires notary) – Spanish
- Pension Directive Form
Kaiser Resources
Self-funded PPO Resources
- Self-funded PPO for Bay Area Roofers
- Anthem Blue Cross website
- UAS Portal for Anthem EOB access
- Find an Anthem Doctor
- Urgent Care Clinics
- Prescriptions: Sav-Rx Base Formulary Drug List
- Prescriptions: Sav-Rx Mail Order Brochure
- Prescriptions: International CRX Plan
- HRA Reimbursement List
- HRA Reimbursement List – Spanish