All of the forms on our web site are in Adobe Acrobat format. If you do not have Adobe Acrobat Reader installed on your computer, please click the "Get Adobe Reader" image above-right to download the software. This software is free to install and use.

You can view and print a form by clicking on the name of the form on the list below. Once you have printed and completed the form you need, please sign the form and mail it to our office or to the address indicated on the form.

Personal Information Changes for Active Employees, Retirees and Survivors:

  • Change of Address for Active Employees
  • Change of Address for Retirees/Pensioners
  • Change in Marital Status
  • Change of Name

    Dependent Changes for Active Employees, Retirees and Survivors:

  • Add Dependents (Active Employees and Retirees Only)
  • Delete Dependents (Active Employees, Retirees and Survivors)
  • Dependent Child Certification Form (for "Other" child)
  • Same Sex Domestic Partner Certification Form

    Retirement Applications:

  • Normal Retirement Application
  • Disability Retirement Application

    Pension Payment Changes:

  • Change of Address for Retirees and Survivors
  • Electronic Fund Transfer (Direct Deposit)
  • Federal Tax Withholding Election Form
  • CA State Tax Withholding Election Form

    Health Benefits:

  • Coastwise Indemnity Plan Claim Form for Medical/Surgical Services
  • Hearing Aid Claim Form
  • Hearing Aid Claim Form for Oregon Kaiser Eligibles Only
  • Provider Nomination Form for Coastwise Indemnity Plan Members in California
  • Coastwise Indemnity Plan Benefits Schedule of Allowances
  • Coastwise Indemnity Plan Enrollment Form
  • Medical Choice Form CA or OR
  • Medical Choice Form WA
  • Dental Choice Form CA Locals 18, 34A, 54
  • Dental Choice Form So. CA Locals 13, 26, 63, 94
  • Dental Choice Form So. CA Locals 29 and 46
  • Dental Choice Form OR
  • Dental Choice Form SF
  • Dental Choice Form WA
  • Subsequent Artificial Limbs and Eyes Claim Form
  • Ophthalmology Claim Form
  • Kaiser/Group Health Cooperative Plans Chiropractic Claim Form
  • Diabetic Durable Equipment Claim Form

    Disability Supplement:

  • Supplemental Disability Claim for California

    Beneficiary Designation:

  • Beneficiary Designation Form

    Weekly Indemnity Benefit:

  • Weekly Indemnity Claim Form

    Taxation Notices and Election Forms:

  • Important Notice Regarding Taxation
  • IRS Publication 501 Worksheet

    General Forms:

  • Record Change Form


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