Welfare Forms

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Complete & Print Forms - You can complete most of the forms listed below right on your computer before you print. Simply click on a field in the form and type in the appropriate information. Then print the completed form, sign and mail it to the Trust Office. These printable forms are in PDF format. To read and print them, you need the free Adobe Acrobat Reader (which is probably already installed in your system). Click here if you do not have Adobe Reader installed on your system.

General/Privacy

  • Address Change Form — Form for address changes.
  • Privacy Notice — This is the official Privacy Notice of the Plan as required by the HIPAA regulations.
  • Release of Health Information — The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects the health information of each patient. The Alaska Teamster Welfare Trust (the "Plan") is prohibited from releasing protected health information except in very specific circumstances. You have the right to request that the Plan release your protected health information to another party (such as another family member); however, you must provide such permission in writing.

Enrollment/Eligibility

Brochures

HRA for AILU Only

  • HRA Claim Form — Claims form for HRA participants.
  • Direct Deposit — Authorization for reimbursements from your Health Reimbursement Arrangement directly to your bank account.
  • How to Guide — HRA mobile application instructions and online how to guide. The mobile application and secure online portal gives you 24/7 access to view information and manage your Flexible Spending Accounts.

Retirees

Legally Required