Forms

Anthem Out-of-Network Claims Reimbursement
Beneficiary Designation
Eyemed Out-of-Network Provider Reimbursement
OptumRx Prescription Drug Claim Form

Updating Your Contact Information

Contact the Fund Office if you have a change in your home address, phone number, or email:

• contact@ufcwnewenglandhealthfund.com
• 860-470-8551
• 888-705-1092 (toll-free)
• UFCW New England Health Fund
  290 Post Road West
  P.O. Box 5160
  Westport, CT 06880-9917

Questions?

Contact the Fund Office for questions about benefits eligibility, enrollment, and coverage:

• contact@ufcwnewenglandhealthfund.com
• 860-470-8551
• 888-705-1092 (toll-free)