Puget Sound Electrical Workers Trusts



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• Forms
  • Change of Address Form
  • Dental Claim Form
  • Enrollment/Beneficiary Form
  • Enrollment/Beneficiary Form - Associates
  • Maternity Benefits Application
  • Medical or Time Loss Claim Form
  • Prescription - Costco Mail Order Form
  • Prescription - Elixir - 2023 EX Formulary
  • Prescription - Elixir Mail Order Form
  • Prescription - Elixir Reimbursement Form
  • Vision Claim Form
• Privacy and Disclosures
  • Authorization for Disclosure of Protected Health Information
  • Health & Welfare Trust – Notice of Privacy Practices
  • Revocation of Protected Health Information Disclosure