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Remember These Vital Documents and Keep Them Updated as Needed (especially as your life changes)

With so many things competing for your attention these days, staying on top of the documents needed to maintain your pension and health benefits might get overlooked. Yet, these documents are an essential part of the Plans’ ability to provide you, your dependents and beneficiaries the benefits you’ve earned.

Below is a list of important documents and a description of who should have them on file. Submitting them and keeping them up to date can prevent interruptions to your benefits and, with certain forms, ensure that the Plans have the proper authorization to release your information in accordance with your wishes.

Name of Form Pension of Health Related Who should file? Where to find it
Adult Dependent Authorization Form Health Dependents age 18 and over who are covered under the Health Plan and want their health-related Plans mail sent to an address other than the primary participant’s.
Beneficiary Designation Form Pension All participants should complete this form to ensure their pension benefits go to the beneficiaries they desire, and update it with any life changes, such as divorce and birth or adoption of a new child.
Change of Address Form Both Individuals age 18 and over who would like to update the address to which their Plans-related mail gets sent.
  • dgaplans.org/forms (pdf)
  • myPHP benefits portal (directly change your address using the My Profile tab)
Coordination of Benefits Form Health Individuals covered under the Health Plan must submit this form annually or if there are any changes or termination of coverage with other insurance companies. Your claims will be denied without this form.
  • In your annual open enrollment packet
  • dgaplans.org/forms (pdf)
  • myPHP benefits portal (pdf and DocuSign versions)
Dependent Confirmation Form Health Participants covering dependents need to verify their covered dependent(s) annually by attesting they continue to meet the Health Plan’s definition of an eligible dependent.
  • In your annual open enrollment packet
  • By request from the Plans office
Dependent Enrollment Form Health Participants who want to add their dependent spouse and/or child(ren) to the Health Plan. Special enrollment rules apply to add dependents other than at open enrollment.
HIPAA Authorization Form Health Individuals age 18 and over who would like to authorize the Plans to release protected health information (PHI) to an agent to act or make decisions on their behalf in health-related matters only. This document may be used in place of a Health Care Power of Attorney.
Pension Deduction Authorization Form Health Participants who want to pay their monthly health premiums through a deduction directly from their Basic Plan monthly pension benefits.
Power of Attorney (General) Pension Individuals age 18 and over who would like to authorize an agent to act or make decisions on their behalf in pension-related matters only. This document may be used in place of the Third-Party Authorization Form.
  • Consult your attorney
Power of Attorney (Health Care) Health Individuals age 18 and over who would like to authorize the Plan to release information to an agent to act or make medical decisions on their behalf in health-related matters only. This document may be used in place of the HIPAA Authorization Form.
  • Consult your attorney
Power of Attorney (Special) Specified by the participant Individuals age 18 and over who would like to authorize an agent to act or make decisions on their behalf only in matters as specified in the Special Power of Attorney.
  • Consult your attorney
Third-Party Authorization Form Pension Individuals age 18 and over who would like to authorize the Plans to release information to an agent in pension-related matters only. This document may be used in place of a General Power of Attorney.