Local 559 Member Forms

 

Please access the following links for Member Forms:

Accidental Dismemberment of Loss of Vision Claim

Affidavit Acknowledging Paternity

Affidavit of Financial Responsibility

Affidavit of Marital Status

Affidavit of Residence of Spouse

Affidavit of Spouse No Longer Living with Member

Annual Information Request Form (AirForm)

Anthem COB Workers Comp

Davis Vision Prior Approval

Group Life Conversion

Life Accidental Death Claim - English

Life Accidental Death Claim - Spanish

Life Beneficiary Designation

Life Waiver of Premium or Continuation of Benefits

Living Benefit Claim

Massage Therapy Reimbursement

Prescription Reimbursement

Suboxone Prior Authorization

Weekly Accident/Illness - Not Work Related

Weekly Accident/Illness - Work Related