Alaska Laborers Trust Funds

Forms

Enrollment and Claims

Authorization Agreement for Electronic Pension Benefit Deposit
Change of Address
Enrollment/Beneficiary Form – Spanish
Enrollment/Beneficiary Form
Medical, Dental, or Time Loss Claim Form
VSP Out-Of-Network Reimbursement Form (Only self submitted non-VSP network claims)
CVS – How To Submit a Digital Prescription Claim
CVS – Prescription Reimbursement Claim Form

Privacy and Disclosures

Authorization for Disclosure of Protected Health Information
Health & Security Fund – Notice of Privacy Practices
Revocation of Protected Health Information Disclosure
Preauthorization

Preauthorization is required for all non-emergency hospital admissions and certain out-patient services providers must call Aetna at 1-888-632-3862.

For more information call WPAS: (855) 815-2323.

PPO Hospital in-patient and out-patient services in the municipality of Anchorage or the Mat-Su Borough are provided by Alaska Regional Hospital. If you do not use this PPO facility financial penalties will be assessed.

Where to send completed Medicare, Dental and Member Paid Claim forms

Alaska Laborers Health & Security Fund
P.O. Box 34567
Seattle, WA 98124-1567

Mail all other completed forms

Alaska Laborers Trusts
P.O. Box 34203
Seattle, WA 98124-1203