F-52 Emergency Assistance Fund Benefit Request Form (apply & submit online)
To request LRFA Emergency Assistance Fund benefits, members must submit the form along with all relevant documents.F-66 Medicare Supplemental Benefit Request Form
To request LRFA Medicare Supplemental Plan benefits, members must submit a completed LRFA F-66a along with all relevant Medicare documents.F-18 Health Supplemental Benefit Request Form
To request LRFA Health Care Plan benefits, member submit a completed form F-18, along with all hospital and physician bills (or legible copies).F-46 Hospital Supplemental Benefit Request Form
To request LRFA Supplemental Health Care benefits, member must complete and sign the benefit request form, F-46a, and submit it along with all itemized hospital and physician bills.F-104 Medical Travel Benefit Request Form
To request LRFA International Travel Plan benefits, member must complete and sign the benefit request form, F-104, and submit it along with all itemized hospital and physician bills.F-103 Visitors from Abroad Benefit Request Form
To request LRFA Visitors from Abroad benefits, member must complete and sign the benefit request form, F-103, and submit it along with all itemized hospital and physician bills.F-39 Final Expense Benefit Request Form
To request LRFA Final Expense benefits, beneficiary or family member must complete and sign the benefit request form, F-39, and submit it along with approprate documentation.