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?
I just got divorced – how does this affect my Annuity Fund?
You must notify the Annuity Fund office and supply the office with your complete divorce decree and any supporting documents (stipulation agreements). If your former spouse is entitled to a portion of your Annuity Fund account, a QDRO should be submitted to the Annuity Fund office for review and consideration.
In the event of a divorce, you should review your beneficiary on file with the Annuity, Central Pension and Health and Benefit Funds.