Premera Forms

Medical Claim Form  *
Prescription Drug Reimbursement *
Medco by Mail Order Form *
 
PDF versions of the forms marked with * are "Typewriter Enabled". This allows you to use the Acrobat 7 or 8 Reader "Typewriter tool" to fill out these forms. To use this feature you will need to save the PDF form on your computer and then open it from the Acrobat Reader.

Catastrophic Leave

We have a “Catastrophic Leave” account that is maintained by our union for our members to access in times of extreme need and/or extended absence from the job due primarily to FMLA issues.  Each member who qualifies has access of up to 30 days of catastrophic leave per year for such extended absences.
 
This leave bank is a benefit we negotiated for in the last two contracts and there is no deduction from any active members leave or contribution required for this benefit.  The bank is funded entirely from excess sick leave that people will lapse upon separation from the state that is deposited in this account upon their termination of service. 

The process is fairly easy and a simple form is all that is required.   The forms are kept at the respective union offices across the state presently, but I will ask our webmaster to incorporate the form and the process onto our web site for easier access.
 
Feel free to contact me if you have any questions at 465- 6178 or my work email is: john_white@fishgame.state.ak.us.
 
I hope none of you ever have to use these hours but I wanted to let everyone know that they are available.
 
John White
President, Local 4900 State Supervisors

Catastrophic Leave Form

Alaska Care (Aetna) coverage prior to July 1, 2007

Alaska Care Prescription Benefits Claim Form
Atena Rx Home Delivery -New Participant Form
Aetna Dental Benefit Request
APEA / AFT New Member Form
Aetna Navigator