Los Angeles County Fire Fighters Local 1014 Health and Welfare Plan

Download Forms!

VSP Vision Benefits

Dec 09, 2021

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Download:

VSP Out-Of-Network Reimbursement Form.pdf

VSP Benefits Summary 2022.pdf

Authorization for Release of Health Information - HIPAA

Oct 24, 2014

Authorization for Release of Health Information Form (HIPAA)
Download:

HIPAA Release Form 1-2020.pdf

Misc forms

Jan 27, 2005

Misc Forms
Download:

Continued Eligibility Form.pdf.pdf

Union Membership Application 11-26-19.pdf

Change of Beneficiary Application-11 26 19 (2).pdf

Third Party Address Form.pdf

Page Last Updated: May 23, 2022 (10:03:00)

Contact Info
Local 1014 Medical Plan
3460 Fletcher Avenue
El Monte, CA 91731
800-660-1014
626-401-3406