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Participant Center For All Participant Groups

General Information

Authorization to Release Protected Health Information (PHI) Form
This form should be used if you would like another person or entity other than yourself to receive your protected health information.

Change of Address Form (NEW On-Line)
This form should be used to notify EIT of your new address. You can also register for an EIT Online Account to make future address changes.

Dependent Information Request Form
Federal Law now requires that health plans report Social Security Numbers (SSNs) for covered dependents. Please utilize this form to provide SSNs for all dependents.

Direct Deposit Form
Direct Deposit is now mandatory for all payments including Pension, Supplemental Unemployment and Disability.

Disability Application Package
Disability application instructions and forms to apply for Disability Benefits.
(Disability Benefits do not apply to Participants of the Participatory Plan or who are currently covered under COBRA)

Group Life Beneficiary Designation Form
This is a form to fill out and mail to us if you would like to designate a beneficiary or update beneficiary information.

Use the forms below for Pension requests. Qualified Domestic Relations Order (QDRO) Request for Disabled Dependent Coverage
Request for Disabled Dependent Coverage Form.

Supplemental Unemployment Benefit (SUB)
As of 3/29/2020, EIT is no longer accepting paper/email/fax applications or certifications. You must use the online forms below. Subrogation Questionnaire

Workers’ Compensation Disability Statement
Effective November 1, 2015, if you are injured at work, you must file a completed Workers’ Compensation Disability Statement within 90 days of the later of either the last day you worked contributed hours or the date of your injury. Claims filed after 90 days will not be accepted and no Disability Hours will be credited to maintain your health insurance.

Useful Tax Forms
  • IL W-4  (Illinois Employee Withholding)
  • IL W-5-NR  (Illinois Nonresidence Statement)
  • IRS W-4  (Federal Employee Withholding)
  • IRS W-4P  (Federal Pension Withholding)
  • IRS W-4S  (Federal Sick Pay Withholding)
  • IRS W-9  (Request for Taxpayer Identification)
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