Do you need to change beneficiaries? Add or remove dependents? Update payment information?
Retiree Medical & Dental Plan Change Forms
- For Retirees of Local 88, Non-Represented, ONA, JCSS, MCCDA, DSA/CD, Dentists, Physicians, Prosecuting Attorneys (pdf)
- For Retirees of FOPPO, IUOE (pdf)
- For Retirees of IBEW (pdf)
Other Required Forms:
- Affidavit of Marriage or Domestic Partnership (pdf)
- Required if adding a spouse/domestic partner