Alaska United Food and Commercial Workers Trust



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• Enrollment
  • Enrollment/Beneficiary Form
• Forms
  • Authorization To Terminate Health Insurance Coverage And Payroll Wage Deduction
  • Avia/RxTE PA Exception Request Form
  • Avia/RxTE PA Exception Request Instructions
  • Change of Address Form
  • Custody - Dependent Status Inquiry
  • Dental Claim Form
  • Injury Details Form Letter
  • Medical Claim Form
  • Opt-Out Health Coverage Form
  • Other Insurance Letter
  • Prescription Drug Program Brochure – Avia Partners
  • Prescription Reimbursement Request Form – Avia Partners
  • Subrogation Agreement
  • Vision – VSP – Out-Of-Network Reimbursement Form
• Privacy and Disclosures
  • Authorization for Disclosure of Protected Health Information
  • Health & Welfare Trust – HIPAA Notice of Privacy Practices
  • Revocation of Protected Health Information Disclosure