Enrollment, Change Forms, COBRA, and Termination Forms

• Eligibility Verification Statement
• TPM Trust Enrollment Form
• TPM Trust Enrollment Change Form
• Notice to Terminate Benefits
• COBRA Qualifying Event Form
• Leave of Absence Layoff Provision Notice

Medical and Pharmacy Forms

• • Premera Member Submitted Claim Form (Dental, Vision, Medical)
  • Premera Pharmacy Mail-Order Form
  • Premera Prescription Reimbursement Form
  • Premera Incident Questionnaire
  • Premera Instructions for Using the Express Mail Order Service
  • LifeWise Member Submitted Claim Form
  • LifeWise Pharmacy Mail-Order Form
  • LifeWise Prescription Reimbursement Form
  • LifeWise Incident Questionnaire
  • TPM Trust Accidental Injury Benefit

Life Insurance and Disability

• TPM Life Participation Agreement
• TPM STD Participation Agreement
• Symetra How to File a Disability Income (DI) Claim
• Symetra How to File a Life Claim
• Symetra Life Claim Packet
• Symetra Short Term Disability (STD) Claim Form

Other Forms

• TPM Trust Affidavit of Domestic Partnership
• TPM Trust FAQs
• TPM Trust Request for Certification of Disabled Dependent 
• VSP (vision) Reimbursement Form