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Forms - 60+ Plan

Access all essential forms for your Benefits of Film plan, including enrollment, claims, and updates—everything you need in one place.

Health Benefits Enrollment, Beneficiary & Change Forms

Beneficiary Forms

60+ Health Plan Opt-in and Beneficiary Form

Complete this form to opt into the 60+ Health Plan and designate your beneficiary.

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Beneficiary Forms

Group Benefits Enrollment Form (Extended Health and Dental)

Fill out this form to enroll in the benefits plan.

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Beneficiary Forms

Group Change Form (Extended Health and Dental)

Use this form to report changes, including adding or removing a family member, if you enrolled in the group plan.

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Beneficiary Forms

Life Insurance - Beneficiary Designation Information and Form

Use this form to designate or update your life insurance beneficiary.

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Extended Health & Dental

Complete this form before your procedure to request coverage for gender affirmation care.

Gender Affirmation Care & Procedure Application

Complete this form before your procedure to request coverage for gender affirmation care.

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A quick guide to help you submit your claim and required documents.

How to Submit Your Claim Online

A quick guide to help you submit your claim and required documents.

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Use this form to submit eligible expenses for fertility, surrogacy, and related family-building services.

Family Building Claim Form

Use this form to submit eligible expenses for fertility, surrogacy, and related family-building services.

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Submit claims for reimbursement of dental expenses (Retiree Group Number: 58198).

Dentalcare Expenses Statement with HCSA M445D-HCSA-W

Submit claims for reimbursement of dental expenses (Retiree Group Number: 58198).

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Submit claims for reimbursement of health care expenses, including physiotherapy, massage therapy, chiropractic services, and more (Retiree Group Number: 58198)

Healthcare Expenses Statement with HCSA M635D-HCSA-W

Submit claims for reimbursement of health care expenses, including physiotherapy, massage therapy, chiropractic services, and more (Retiree Group Number: 58198)

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Drug Coverage

Prescription medication request form for brand name drug coverage

Request for Brand Name Drug Coverage

Complete this form to request coverage for a brand name medication when a generic version causes adverse reactions.

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