Locals 302 and 612 of the International Union of Operating Engineers Trust Funds

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Health & Welfare

Forms


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  • Claim Forms
    • Dental Claim Form
    • Medical/Time Loss Claim Form
    • Notice of Appeal
    • OptumRx Reimbursement Form
    • OptumRx PDP Reimbursement Form — Retirees
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Preauthorization

Inpatient admissions and selected outpatient services require preauthorization. The plan will not pay for any hospital stays which are not medically necessary.

For pre-authorization, please call:
First Choice: (800) 986-9156
Behavioral Health (BHCC): (800) 640-7682

Where to send completed Medical, Dental and Time-Loss Claim forms

LOCALS 302/612 HEALTH TRUST
P.O. Box 34684
Seattle, WA 98124-1684

Mail All Other Completed Forms

Administration Office
P.O. Box 34203
Seattle, WA 98124-1203

F12-02-HomeNoticeNonDiscriminationNotice-2020
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