Forms and Documents

Need to file a claim? Want to know your copay for a specific service? These forms and documents can help you do all that and more. Below you'll find all the UAW Trust forms and documents you'll need, plus a short description to help you find the one you're looking for.


  • Evidence of Coverage
    Learn the details of what your UAW Trust Medicare Advantage plan covers.
  • Annual Notice of Change
    Your Annual Notice of Change tells you about any changes to the cost or benefits in your UAW Trust Medicare plan. Learn more here.
  • Star Ratings
    Find out how your UAW Trust Medicare health care choices are rated.
  • Claims Forms
    Do you need to file a claim for your UAW Trust HMO or PPO plan? Find the documents you need here.
  • Flu and Pneumonia Shot Reimbursement Form
    UAW Trust Medicare members should use this form if they need to be reimbursed for payment for a flu or pneumonia vaccination.
  • Benefit Summaries
    Learn about the benefits available through your UAW Trust plan.

Protected Health Information and Privacy Forms
Your privacy is important to us - and we want to make it easy for you to manage your PHI. Learn more here.