Health & Welfare and Pension Funds
of Philadelphia and Vicinity

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 Weekly Disability Claim Form Weekly Disability Continuation Form
Dental Claim Form Direct Pay Prescription Drug Form
Vision Claim Form Death Benefit Claim Form
HIPAA Authorization Census / Beneficiary Designation Form
Medical Benefit Option Change Form for 2008 Student Verification Form 
Mail Order Form for Prescriptions   Horizon Medical Claim Form
COB Declaration of Health Coverage    

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 Last Date Updated :  01/10/07