Forms, Booklets & Schedules

The following forms are available in Adobe Acrobat PDF format. To get Adobe Acrobat click here

CSA Retiree Welfare Fund

CSA Retiree Welfare Fund Enrollment Form

CSA Retiree Welfare Fund Benefit Book

Healthplex Participating Dentists

Home Health Aide form Instructions
Home Health Aide Claim Form
Home Health Aid Provider Record

SIDS Retiree Schedule of Allowances – January 1 2021
SIDS Dental Claim Form

SIDS Provider Search

GHS Enhanced Medicare Part D Drug Plan 2023 Chart

Click here for the GVS Benefits Breakdown

Click here for the GVS 2-Page Flyer

Click here for the GVS Reimbursement Form

Retiree Welfare Fund & Retiree Chapter Benefits Chart – 2023 

GHI Enhanced Part D prescription Drug Benefit – 2022

Sample 2019 Social Security IRMAA Letter

Survivor Information Packet

Survivor Enrollment Card

CSA Welfare Fund

CSA Welfare Fund Enrollment Form

Age 26 Enrollment Card

Age 26 Application Form

CSA Welfare Fund Benefit Book

NYC Health Benefits Application Form

Optum Direct Reimbursement Form

Healthplex Participating Dentists
Healthplex Active Fees
Healthplex Enrollment Form

CSA Active Dental Schedule — 1-1-2023
SIDS Dental Claim Form

SIDS Provider Search

Click here for the GVS Benefits Breakdown

Click here for the GVS 2-Page Flyer

Click here for the GVS Reimbursement Form

2023 OptumRx Formulary Drug List

Survivor Information Packet

Survivor Enrollment Card

DCC/CSA Welfare Fund

DCC/CSA Welfare Fund Enrollment Form

DCC/CSA In-service Benefits Book

Healthplex Participating Dentists

DCC SIDS Dental Schedule 
SIDS Dental Claim Form

SIDS Provider Search

Click here for the GVS Benefits Breakdown

Click here for the GVS 2-Page Flyer

Click here for the GVS Reimbursement Form

DCC Age 26 Enrollment Form

DCC/CSA Retiree Welfare Fund

Welcome Letter & Benefits At a Glance