ABOUT THE PLAN
Features & Benefits
Facts About the Plan
Schedule of Benefits
Want to Participate?
FOR EMPLOYERS
Eligibility
Employer FAQ's
Administration Manual
Electronic Billing & Pmts.
Update Unit Info
Enrollment
Filing a Claim
Forms
Non-Participating Groups
Open Enrollment
FOR MEMBERS
Eligibility
Member FAQ's
Schedule of Benefits
What if I'm disabled?
Enrollment
Filing a Claim
Forms
HOME
REQUEST FOR CERTIFICATE
Download a printable version
of the form, or complete and submit the form below:
Requested by:
Phone:
Unit # or Group Name:
Member Name:
Social Security Number:
Employee Is:
Active
Retired
Employee Address:
Please be aware that certificates for active members are sent to the employer for distribution.
You can expect to receive your certificate in approximately 30 - 60 days.
