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.