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Washington – Idaho Operating Engineers Trust Funds

Washington - Idaho Operating Engineers Trust Funds

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Forms

The claim forms below are only to be used for claims incurred prior to August 1, 2022. If your claims incurred after August 1, 2022, please visit the Locals 302/612 IUOE Health Fund for the appropriate forms. You may click this link to be re-directed to the Locals 302/612 IUOE Health Fund website.

Enrollment Forms: The WA-ID Health Trust merged into the Locals 302/612 IUOE Health Fund effective 8/1/2022. To enroll, please click on this link to be re-directed to the Locals 302/612 IUOE Health Fund website.

Claim Forms

Medical Time Loss Claim Form
Dental Claim Form
Vision Reimbursement Claims Form
Optum RX – PDP Prescription Reimbursement Request
Optum Rx – Prescription Reimbursement Request
Notice of Appeal Form

Disclosure and Privacy

Notice of Privacy Practices
Authorization to Disclose Protected Health Information
Revocation of Protected Health Information

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