Group Accidental Death & Dismemberment Enrollment Form​ ​

Group Basic Care Hospital Plan Application Form

Group Legal Services Plan Enrollment Form 

Group Hospital Indemnity Insurance Plan Enrollment Form​  

Group Long Term Disability Plan Application Form

Group Short Term Disability Plan Application Form  

Group Term Life Insurance Application Form

 

Plan Rates for Active & PSE APWU Member Plans

​Group Basic Care Bi-Weekly Rates​​

Group Dental Plan Bi-Weekly Rates  

Group Dental Plan Monthly Rates for Associate Members​

Long Term Disability Plan Bi-Weekly Rates 

Short Term Disability Plan Bi-Weekly Rates​ 

Hospital & Home Care Recovery Plan Bi-Weekly Rates

Term Life Insurance Plan Bi-Weekly Rates

Retiree Accidental Death and Dismemberment Insurance Enrollment Form​

Retiree Dental Plan Activation Form ​ 

Retiree Group Legal Services Plan Enrollment Form  

Group Retiree Hospital Indemnity Insurance Plan Application Form

Group Retiree Basic Care Application Form

Retiree Term Life Insurance Application​

 

Rates for Retiree Member Plans

Group Dental Plan Monthly Retiree Rates​

​Group Retiree Hospital Indemnity Plan Monthly Rates​

Group Retiree Term Life Insurance Monthly Rates

Group Retiree Basic Care Insurance Monthly Rates​​

Cancer Plan Insurance Certificates

Click on your State of Residence below to view or print out your applicable Cancer Plan Certificate of Insurance*

Alaska ($30,000)

California

Delaware

Florida

Georgia

Hawaii

Idaho ($15,000)

 

Idaho ($30,000)

Iowa

Louisiana ($15,000)

Louisiana ($30,000)

Maryland

Maine

Michigan

Minnesota

Mississippi

North Carolina

New Mexico

Nevada

Oklahoma

Pennsylvania

South Carolina

Texas

Vermont

West Virginia

Wyoming​

If you reside in one of the following states, click on the Certificate below to view or print out your Certificate of Insurance*

AL, AR, AZ, CT, CO, DC, IL, IN, KS, KY, MA, MO, ND, NE, NJ, NY, OH, RI, TN, WI

Cancer Plan Certificate​

*PLEASE NOTE:  The Cancer Plan Certificate of Insurance, is only applicable for coverage if you're currently paying premiums towards the Cancer Insurance Plan.