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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

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

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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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 Accidental Death & Dismemberment Enrollment Form​ ​

Rates for Active Member Plans

Group Basic Care Bi-Weekly Rates​​

Group Dental Plan Monthly Rates for Associate Members​

Hospital Indemnity Bi-Weekly Rates​

Short Term Disability Plan Bi-Weekly Rates​

Application/Enrollment Forms for APWU Retirees

Rates for Retiree Member Plans

Group Dental Plan Monthly Retiree Rates​

​Group Retiree Hospital Indemnity Plan Monthly Rates​

Group Retiree Basic Care Insurance Monthly Rates​​

Downloads

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Group Accidental Death & Dismemberment Enrollment Form

Group Basic Care Bi-Weekly Rates

Group Dental Plan Monthly Rates for Associate Members

Hospital Indemnity Bi-Weekly Rates

Short Term Disability Plan Bi-Weekly Rates

Group Dental Plan Monthly Retiree Rates

Group Retiree Hospital Indemnity Plan Monthly Rates

Group Retiree Basic Care Insurance Monthly Rates