Pensioned Health and Welfare Forms

• Pensioned_HW_Medicare_Retiree_Enrollment_Form_revised_8.30.2024
  • Enroll for benefits under the Pensioned H&W plan for Medicare retirees.
• Pensioned_HW_Non-Medicare_Retiree_Enrollment_Form_revised_4.25.2024
  • Enroll for benefits under the Pensioned H&W plan for non-Medicare retirees.
• Pensioned OE H&W Fund Medicare Retiree Enrollment Form - Hawaii
  • Enroll for benefits under the Pensioned H&W plan for Hawaii Medicare retirees.
• Pensioned OE H&W Fund Non-Medicare Retiree Enrollment Form - Hawaii 
  • Enroll for benefits under the Pensioned H&W plan for Hawaii non-Medicare retirees.
• Pensioned OE H&W Fund Hawaii Dental Service Enrollment Form 
  • Enroll for benefits under the Pensioned H&W plan for Hawaii non-Medicare retirees.
• Late Enrollment Application for Coverage Under the Pensioned Operating Engineers
  • Complete to enroll in the Pensioned H&W plan if you are a late enrollee.
• Health Net Medicare Programs Disenrollment Form
  • Disenroll members from the Health Net Medicare plan.
• Kaiser Permanente Senior Advantage Disenrollment Form
  • Disenroll family members from the Kaiser Senior Advantage plan.
• 2025 Kaiser Permanente Senior Advantage Enrollment Form - Hawaii      
  • Complete to enroll in the Kaiser Permanente Senior Advantage plan.
• 2025 Kaiser Permanente Senior Advantage Enrollment Form - California           
  • Complete to enroll in the Kaiser Permanente Senior Advantage plan.
• 2025 HMSA Medicare (Senior) Advantage Enrollment Form 
  • Complete to enroll in the HMSA Medicare (Senior) Advantage plan.
• 2025 United Healthcare Enrollment Request Form 
  • Complete to enroll in the UnitedHealthcare Group Medicate Advantage (HMO) plan.