Downloads (Forms)

Enrollment Form
Privacy Statement
HIPAA Authorization Form
HIPAA Authorization Form (Spanish)

Summary Plan Description Booklets

Local 68 Health & Welfare Fund SPD

Summary of Benefits and Coverage

Local 68 H&W SBC 2020

OptumRx Prescription Plan Information

OptumRx Customer Service:  1-800-797-9791
OptumRx Website

These forms are published on this page by Associated Administrators, LLC
on behalf of the Client Fund and are meant solely for the use of their participants.