UAW Retiree Medical Benefits Trust
UBR File Cabinet
Forms


Personal
Health
Information
    

Trust PHI Authorization Instructions and Form
BCBS PHI Authorization Form
BCBS Psychotherapy Authorization Form
BCBS Revocation Form (to revoke an authorization)

Express Scripts 
Direct Claim Forms

Direct Claim Form - Non-Medicare Members
Direct Claim Form - Medicare Members
Retiree
Meetings

Retiree Meeting Presentation/Attendance Request Link
Reference Guides

UBR
Reference
Guide

Chrysler UBR Reference Guide
Ford UBR Reference Guide
GM UBR Reference Guide
Important Information - Handouts
For Members          What You Need to Know About Medicare
Durable Medical Equipment Changes
About the Trust                    
Trust UBR/Retiree Chair Newsletters
For UBRs       
and Retiree
Chairs                  
March 2017
December 2016
February 2016 
December 2015
August 2015 
February 2015
October 2014
June 2014
February 2014       
Medical Benefit Details   

Click here to access details of a specific plan. 

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