Locals 302 and 612 of the International Union of Operating Engineers Trust Funds



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• Claim Forms
  • Dental Claim Form
  • Medical/Time Loss Claim Form
  • Notice of Appeal
  • Authorization for Provider Appeal (For a Provider making an Appeal on the Member's behalf)
  • OptumRx Reimbursement Form
  • OptumRx PDP Reimbursement Form — Retirees
  • VSP Out-Of-Network Reimbursement Form
• Enrollment
  • Enrollment/Beneficiary Form
• Disclosure and Privacy
  • Authorization for Disclosure of Protected Health Information
  • Revocation of Protected Health Information Disclosure
  • Notice of Privacy Practices — Health & Security Trust
  • Notice of Privacy Practices — Dental