View, download and/or print current Health Plan forms.  

AFTRA H&R general forms
 Performer Registration Form
 Performer Address Change Form - Version 1 (form fields may be completed on a computer) 
 Performer Address Change Form - Version 2 (highest quality for printing multiple quantities)

 
AFTRA Health Plan forms
 Performer Enrollment Form
 Dependent Change Form
 Medical Claim Form
 Dental Claim Form
 Health Plan Premium Deduction from Pension Benefit
 Senior Citizen Health Program Enrollment Form
 Employer Request for Staff Performer Coverage Form (to be completed by employers)
 CIGNA Provider Nomination Form

Medco forms
Visit and register with www.medco.com to download current Medco Pharmacy mail order forms (on the left menu, under “Prescriptions & benefits” select “Forms & cards” and then “Print a mailorder form by clicking here,”) and to access other resources and information from Medco.

COBRA continuation coverage notice and election form 
  COBRA Continuation Coverage Election Form

Health Plan procedures
 Procedures to request Certificates of Creditable Coverage


Same-sex domestic partner buy-up forms
(If you qualify for the Individual Health Plan)
 Declaration Form
 Checklist


Same-sex domestic partner family coverage forms
 Declaration Form
 Affidavit of "Dependency" for Tax Purposes
 Checklist


Privacy forms
 Authorization Form
 Request for Confidential Communications
 Authorization Revocation
 Request for Access to Protected Health Information
 Request for Amendment of Protected Health Information


Aetna life insurance and accidental death and dismemberment coverage forms
 Proof of Death Form
 Accelerated Death Benefit Form
 Accidental Dismemberment /Personal Loss Claim Form
 Attending Physician Statement

Note to View .PDF Files

The best way to print the forms is to download them as PDF files. To open the PDF file you will need Adobe Acrobat Reader which is available free.