Forms for Pension and Retirement

General

Change of Address – Retirees
Parent and Guardian Affidavit
Request for Pension Estimate

Health Care Employees Pension Fund

Aetna MAPD Medical Waiver Request Form – for Retiree, Spouse and Physician
Aetna Medicare Advantage Plan Opt-In Form
Aetna Medicare Advantage Plan Opt-Out Form
Affidavit for Name Change
Affidavit for Unlocatable Spouse
Application for Disability Pension
Application for Normal or Early Pension
Application for Surviving Spouse Pension
Beneficiary Form for Pension Benefits
Pension Payment Election Form
Enrollment Form – Pension Fund Only
Request for Pension Estimate
Statement of Claim for Medicare Part B Premium Reimbursement

Former 144 Hospital Division

Affidavit for Name Change
Application for Normal, Early or Disability Pension
Beneficiary Form for Pension Benefits

Greater New York

Aetna MAPD Medical Waiver Request Form – for Retiree, Spouse and Physician
Aetna Medicare Advantage Plan Opt-In Form
Aetna Medicare Advantage Plan Opt-Out Form
Affidavit for Name Change
Affidavit for Unlocatable Spouse
Application for Normal, Early or Disability Pension
Application for Surviving Spouse Pension
Beneficiary Form for Pension Benefits
Pension Payment Election Form
Request for Pension Estimate

Home Care

Affidavit for Name Change
Affidavit for Unlocatable Spouse
Application for 36-month or 60-month Guarantee Pension
Application for Normal, Early or Disability Pension
Beneficiary Form for Pension Benefits
Beneficiary Form for Single Working Members
Pension Payment Election Form
Request for Pension Estimate