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Forms for all actively working APWU members

Before completing an application, be sure to review the plan information for eligibility, options, and a complete description of the coverage.

  

Group Hospital & Home Care Recovery Plan Application Form

Group Dental Plan Activation Form

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


 

Rates for Active Member Plans

Group Basic Care Bi-Weekly Rates​​

Group Dental Plan Bi-Weekly Rates  

Group Dental Plan Monthly Rates for Associate Members​

Hospital Indemnity Bi-Weekly Rates​ 

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

 

Application/Enrollment Forms for APWU Retirees

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​​

 

 

 

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Downloads

Downloadable insurance applications and rate charts currently available. Click on the link and you can view or download the form.

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