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



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• Claim Forms
  • Dental Claim Form
  • Medical/Time Loss Claim Form
  • Notice of Appeal
  • OptumRx Reimbursement Form
  • OptumRx PDP Reimbursement Form — Retiree
  • VSP Out-Of-Network Reimbursement Form — Only self submitted Non-VSP network claims
• Enrollment
  • Enrollment/Beneficiary Form
• Disclosure and Privacy
  • Authorization for Disclosure of Protected Health Information
  • Notice of Privacy Practices — Health & Security Trust
  • Notice of Privacy Practices — Dental
  • Revocation of Protected Health Information Disclosure