APWU Active Member Forms

Before completing an application, be sure to review the plan information for eligibility,

options, and a complete description of the coverage.

Accidental Death & Dismemberment Enrollment Form

Group Basic Care Hospital Plan Application Form

Group Basic Care Bi-Weekly Rates

Group Dental Plan Activation Form

Group Dental Plan Bi-Weekly Rates 

Group Legal Services Plan Enrollment Form

Hospital Indemnity Insurance Plan Enrollment Form

Hospital Indemnity Bi-Weekly Group Rates

Long Term Disability Plan Application

Long Term Disability Pay Period Rates

Short Term Disability Plan Application

Short Term Disability Plan Rates

Term Life Application Form

APWU Retiree Member Forms

Retiree Accidental Death and Dismemberment Insurance Enrollment Form

Retiree Dental Plan Activation Form 

Retiree Group Legal Services Plan Enrollment Form

Retiree Hospital Indemnity Insurance Plan Enrollment Form

Retiree Basic Care Enrollment Form

Retiree Term Life Insurance Application