Forms

Healthcare

Prescription

Employer Services

Vision

Disability

401k

Local 292 Pension

SUB


Healthcare

Link to Claim Information
(To Submit Electronically access via member login)

Loss of Time Form

Loss of Time Update Form

Loss Of Time Form (Mental Health/Chemical Dep.)

Subrogation Agreement

Healthcare Benefiary Designation

 

Prescription

Prescription Reimbursement

 

Employer Services

Payroll Reports - LEA

Payroll Reports - Commercial/Residential

Vacation / Holiday

401k Enrollment Form

401k Deduction Form

Healthcare Participation Agreement

Internet Shop Report
(to receive a password to access this online report, call 952-591-7733 ext. 484)

 

Vision

Safety Eyeware Form
Contact Benefits Office at (952) 591-7733 Ext. 487

 

Disability

Loss of Time

Loss of Time Update

 

401k

Enrollment Form

Deduction Form

 

Local 292 Pension

Direct Deposit Form

 

SUB

Beneficiary Form

SUB Verification

 

 
 
 
 
 

 

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