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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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 Dental Plan Activation Form

Group Accidental Death & Dismemberment Insurance Plan Enrollment Form

Group Basic Care Hospital Insurance Plan Application Form

Group Legal Services Plan Enrollment Form

Group Long Term Disability Income Insurance Plan Application Form

Group Short Term Disability Income Insurance Plan Application Form

Group Term Life Insurance Plan Application Form

 

Rates for Active Member Plans

Group Basic Care Insurance Plan Bi-Weekly Rates

Group Dental Plan Bi-Weekly Rates

Group Dental Plan Monthly Rates for Associate Members

Group Hospital Indemnity Insurance Plan Bi-Weekly Rates

Group Long Term Disability Insurance Plan Bi-Weekly Rates

Group Short Term Disability Insurance Plan Bi-Weekly Rates

Group Hospital & Home Care Recovery Insurance Plan Bi-Weekly Rates

Group Term Life Insurance Insurance Plan Bi-Weekly Rates

 

Application/Enrollment Forms for APWU Retirees

Group Retiree Accidental Death and Dismemberment Insurance Enrollment Form

Retiree Dental Plan Activation Form

Retiree Group Legal Services Plan Enrollment Form

Group Retiree Basic Care Application Form

Group 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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