ASEA AFSCME Local 52 Health Benefits Trust is in Alaska

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For the forms not marked "Submitable online":

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  • You can then print and  fax or mail it to the ASEA Health Trust Administrator for processing.
Name Description Submittable online
Download
Deferral of Health Benefits This form, for seasonal employees, allows you to defer your coverage for one or two calendar months, extending your coverage one or two months past the date your coverage would otherwise terminate. Yes linkavailable
Wildland Fire and Resource Technicians, Natural Resource Technicians, and Foresters Deferral of Health Benefits This form, for LTNP Division of Forestry employees, allows you to defer your coverage for one or two calendar months, extending your coverage one or two months past the date your coverage would otherwise terminate.

 

linkavailable
Employee Information Use this form to report your personal information (name, address, etc.) or your work status. Yes linkavailable
Family Information Use this form to submit information about yourself, your spouse and your dependents. This form also allows you to report other insurance coverage for you and your dependents, for Coordination of Benefits. Yes linkavailable
Flexible Benefits Enrollment for Full-Time Employees Enroll online or use this form to enroll by email, mail or fax if you are a full-time employee. You may change your mind after you enroll either by revising your online enrollment or by completing and turning in a new FT Benefits Enrollment Form via mail, or fax to the ASEA Health Trust Administrator within 30 days of your date of hire or the date you change bargaining units, or move from part-time to full-time or vice versa.   linkavailable
Flexible Benefits Enrollment for Part-Time Employees Enroll online or use this form to enroll by email, mail or fax if you are a part-time employee. You may change your mind after you enroll either by revising your online enrollment or by completing and turning in a new PT Benefits Enrollment Form via mail, email or fax to the ASEA Health Trust Administrator within 30 days of your date of hire or the date you change bargaining units, or move from part-time to full-time or vice versa.   linkavailable
Health Benefits ID Card This handy card gives you contact numbers and claims information you can share with your provider. Yes  
Other Coverage Statement Use this form when a qualified beneficiary becomes covered under another group health plan, becomes entitled to Medicare, or is determined to be no longer disabled. Yes linkavailable

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