FORMS

Welfare

2022 Welfare Plan Summary of Benefits & Coverages

2021 Welfare Plan Summary of Benefits & Coverages

2021 Excellus Health Insurance Plan Features

2021 Welfare Plan Summary Plan Description

Dental Claim Authorization Form

Summary of Privacy Practices

Authorization to Release Information Form

Coverage Rights Under Cobra

ULLICO Life Insurance Beneficiary Form

Important Information regarding Prescriptions

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Pension

Pension Plan Summary Plan Description

Pension Direct Deposit Authorization Form

Pension Death Beneficiary Designation Form

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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