Forms and Documents - Transit Employees' Health and Welfare Plan - Transit Employees' Health and Welfare Plan

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New Hire Enrollment

New Hire Enrollment Form

Green Authorization Card

Universal Opt-Out Form

Spousal Credit / Opt-Out Form

Notice of Privacy Practices
Open Enrollment

Affidavit of Domestic Partnership Form

Affidavit of Termination of Domestic Partnership Form

Disability Certification for Over-age Dependents Form

Enrollment Change Form

SPOOT Form Revised

SPOOT Form Revised for Dependent Child
Life and Accident Insurance

Beneficiary PDF
Retiree

Retiree Change of Address Form

Retiree’s Delta Dental Enrollment-Disenrollment Form
Short Term Disability

Short Term Disability Application MD

2022 VA STD Application

2022 DC STD Application
Long Term Disability

Long-Term Disability Benefit Plan