FORMS AND RESOURCES
FORMS
For your convenience, electronic versions of some frequently used forms are provided below. For other forms (Enrollment/Changes, Beneficiary, Wage Indemnity, SUB Plan, Income Continuance, Life/AD&D) please contact the Welfare Plan office.
- Optical Claim Form
- PBC Claim Form – Active Employees
- PBC Claim Form – Retired
- Children’s Orthodontics Reimbursement Slips 2021
- Bereavement Wage Loss Reimbursement Form
- Jury Duty Reimbursement Form
- Pro-Rating on Dental/Hearing Aids – How it Works
- Information for Dental Clinics
- Children’s Orthodontics Information Sheet
ANNUAL REPORTS
- 2025 Summary Newsletter/Report
- 2024 Annual Summary Newsletter/Report
- 2024 Annual Report (Full Version)
- 2023 Annual Summary Newsletter
- 2023 Annual Report (Full Version)
- 2022 Annual Summary Newsletter
- 2022 Annual Report (Full Version)
- 2021 Annual Report (Full Version)
PACIFIC BLUE CROSS BOOKLETS, ETC.
Booklets Effective January 1, 2026
- Local 213 Active Employees Pacific Blue Cross booklet < 65
- Local 213 Active Employees Pacific Blue Cross booklet 65+
- Local 213 Retired Employees Pacific Blue Cross booklet
Communications on Plan Design Changes Effective January 1, 2025
Booklets Prior to January 1, 2025
- Local 213 Active Employees Pacific Blue Cross booklet < 65
- Local 213 Active Employees Pacific Blue Cross booklet 65+
- Local 213 Retired Employees Pacific Blue Cross booklet
MEMBER & FAMILY ASSISTANCE PROGRAM MATERIALS/REHAB PLAN
- Members and Family Assistance Program Overview
- Homeweb – Online Resources Fact Sheet
- EFAP Orientation Registration
- Buildstrong – How It Works Brochure
WAGE INDEMNITY
______________________________________________________________________________________________________________________________________________________________________________
INFORMATION SESSIONS
- February 2025 Welfare Plan Information Session Slide Deck
- February 2025 Retirement Information Session Slide Deck
- Spring 2024 Welfare Plan Information Session (Slide Deck only) – apologies to plan members but this recording did not work. Slide deck provided for reference purposes.
- Fall 2023 Retirement Session (Recording)
- Fall 2023 Welfare Plan Information Session (Recording)
______________________________________________________________________________________________________________________________________________________________________________