FORMS

Welfare

Welfare Plan Summary Plan Description

Letter to Dental Providers (Patient Claim Procedure)

Summary of Privacy Practices

Authorization to Release Information Form

Coverage Rights Under Cobra

ULLICO Life Insurance Beneficiary Form

Important Information regarding Prescriptions

2024 Benefit Brochure - Signature Hybrid 1 Plan

2024 Benefits Brochure - Blue Choice 25 Plan

2025 Benefit Brochure - Signature Hybrid 1 Plan​​

2025 Fully Insured Large Group Wellbeing Brochure

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Pension

Pension Plan Summary Plan Description

Pension Direct Deposit Authorization Form

Pension Death Beneficiary Designation Form

2023 Annual Funding Notice

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Supplemental

Supplemental Retirement Plan Summary Plan Description

In-Service Withdrawal/Rollover Form

Supplemental Death Beneficiary Designation Form

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Other Benefits

Rochester Homebuyer Services Grant Assistance Programs

$10,000 ESL First-Time Homebuyer Grant

NeighborWorks Community Partners Down Payment & Closing Cost Plus Loan

Asbestos Exposure & Construction Workers Fact Sheet

Wage & Benefits Sheet - June 30, 2022, to June 4, 2023

Wage & Benefits Sheet - June 5, 2023, to May 31, 2024