Downloadable Forms

We have made copies of forms available for you to print from your computer. Click the links below to access the forms in portable document format (PDF). (You need Adobe Acrobat on your computer to read a PDF format. If you do not have the latest version of Adobe Acrobat, you can download it for free. Keep in mind that some forms may take a few minutes to download.) If you don't see the form you need here, or you have questions about which form to use, call the Trust office at (239) 936-6242.

In addition, eligible Trust participants (both retirees and their spouses) are automatically enrolled in the Trust’s Indemnity program for medical coverage when you retire.

If you are not yet eligible for Medicare, there’s another health care option that offers even greater flexibility and coverage — the Preferred Provider Organization (PPO).

To enroll in the PPO...

PPO enrollment is based on your location, please use the form that applies to you.

For Pennsylvania, Illinois, Virginia and Oklahoma: Highmark Enrollment Form

For New York and Georgia: Please contact the Trust to determine which form to use. All other states: UHC Enrollment Form (UMR).

Other Forms:

To change your life insurance beneficiary

To change your address or marital status

Direct Payment Enrollment Form

Important:

You must notify the Trust office immediately when you and/or your spouse become eligible for Medicare for any reason other than attaining age 65.

Write or call the Trust at:

G.M.P. - Employers Retiree Trust

5245 Big Pine Way, S.E.

Fort Myers, FL 33907-5998

Phone: (239) 936 6242