In response to COVID-19, the Fund Office closed temporarily in mid-March while initializing its business continuity plan. 

Currently, the Fund Office is fully operational with some staff working in the office and some staff working remotely. We do not currently anticipate any service delays related to the COVID-19 pandemic at this time.

(updated 9.1.2020)

Forms

Forms

Form Name Description Form Category Download
Claim Form HRA
Claim Form - Recurring and Third Party To file for recurring claims payable to a third party HRA
Continued Coverage for Disabled Child HRA
Dependent Change Form Form to add dependents HRA
HRA - Opt Out Form HRA
HRA -Attestation Form HRA
HRA Enrollment Form HRA
HRA Forms Please find HRA Forms on the HRA Account Login Page. To get there, hover over the LOGIN menu option and select HRA Account Login. HRA
Insurance Premium Reimbursement Claim Form HRA
Legal Name Change Form HRA
PHI Release Form Authorization to release personal health information HRA

Homepage - Announcements

Welcome to the Fund Office!