The Following Forms are available for your use

Download and print, or follow the link to print the forms you need.
If the form you need is not on the list, contact us and we will do our
best to provide it for you:

To Request a Form, please email me at:  Melody– doublediamond55@yahoo.com

 

NOTE From MELODY:  VIA Beneftis does not want the non-personalized forms in the system.  They slow down the process and tracking.  All forms, from VIA Benefits, will be mailed to them, if they request, with their bar code on the form if required, or VIA Benefits will help them do the form online.  Blank forms for VIA Benefits have been removed below.

Click on link in the lefthand column to download respective form(s)

 

   

Humana Prescription Order Form

 

Report a Death

Not a form, but this information from the GE Benefits website:  To report a death of a retiree or a retiree’s dependent, please contact the GE Pension Benefit Inquiry Center at 1-800-432-3450, Monday-Friday, 9:00 am-3:00 pm Eastern Standard Time.  

HIPPA Form

Use this form to authorize the release of your personal health information (medical/dental/vision) to a third party designee you identify (such as a family member, legal representative or human resources representative).

Change of Beneficiary Form

Use this form to change your beneficiary for Life Insurance Plans, GE Savings and Security Plan (S&SP) and/or GE Pension Plan. It is a self-contained form that can be completed online or downloaded and printed to be manually filled out.

Letter describing changes to GE Healthcare Plan for Hourly Retirees, dated 7-2015, Effective 1-2016

This is the original letter addressed to hourly employees outlining the requirements for obtaining the $1,000 RRA Supplementary payment. Specifically regarding the need to sign up for either Medigap or Part D coverage (or both) through One Exchange.

Letter describing changes to GE Healthcare Plan for Salaried Retirees, dated 9-2014, Effective 1-2015

This is the original letter addressed to salaried employees outlining the requirements for obtaining the $1,000 RRA Supplementary payment. Specifically regarding the need to sign up for either Medigap or Part D coverage (or both) through One Exchange.

Emergency Assistance Application

HOURLY–Use this form to apply for emergency assistance in the event of financial  hardship due to Personal reasons (death in the family, etc) or in the event of financial hardship due to natural disasters.

 GE Matching Gifts

 In 1954, the GE Foundation created the concept of a corporate matching gift program to support employees in their personal philanthropy and charitable giving by providing a one-to-one (1:1) monetary match.