41![Claim Form E-mail, fax, or mail completed form and itemized verification to third-party administrator. Instructions on reverse. Fillable version at www.rehnonline.com. Montana VEBA HRA Third-party Administrator (TPA) Claim Form E-mail, fax, or mail completed form and itemized verification to third-party administrator. Instructions on reverse. Fillable version at www.rehnonline.com. Montana VEBA HRA Third-party Administrator (TPA)](https://www.pdfsearch.io/img/ca7201aa77e253d83bf22441f2cc078d.jpg) | Add to Reading ListSource URL: benefits.mt.govLanguage: English - Date: 2013-08-14 12:13:26
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42![Pension / Management / Industrial relations / Voluntary Employee Beneficiary Association / Employment compensation / Human resource management / Sick leave Pension / Management / Industrial relations / Voluntary Employee Beneficiary Association / Employment compensation / Human resource management / Sick leave](/pdf-icon.png) | Add to Reading ListSource URL: hr.wa.govLanguage: English - Date: 2014-07-17 15:01:43
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43![HAWAII EMPLOYER‐UNION HEALTH BENEFITS TRUST FUND FOR ACTIVE EMPLOYEES FORMERLY UNDER THE HSTA VEBA BU 05, 45 EMPLOYER/EMPLOYEE CONTRIBUTIONS EFFECTIVE JANUARY 1, 2012 HAWAII EMPLOYER‐UNION HEALTH BENEFITS TRUST FUND FOR ACTIVE EMPLOYEES FORMERLY UNDER THE HSTA VEBA BU 05, 45 EMPLOYER/EMPLOYEE CONTRIBUTIONS EFFECTIVE JANUARY 1, 2012](https://www.pdfsearch.io/img/ddde6106e1e74d699c97f60c0230d71a.jpg) | Add to Reading ListSource URL: files.hawaii.govLanguage: English - Date: 2013-01-24 16:44:12
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44![Published October 30, 2008 CENTERS FOR MEDICARE & MEDICAID SERVICES RETIREE DRUG SUBSIDY (RDS) PROGRAM GUIDANCE TRANSITIONING RDS RETIREES TO A GROUP HEALTH PLAN THAT USES A VEBA AS A FUNDING MECHANISM Published October 30, 2008 CENTERS FOR MEDICARE & MEDICAID SERVICES RETIREE DRUG SUBSIDY (RDS) PROGRAM GUIDANCE TRANSITIONING RDS RETIREES TO A GROUP HEALTH PLAN THAT USES A VEBA AS A FUNDING MECHANISM](https://www.pdfsearch.io/img/f46f34089e66c868f2abce7c60bb199d.jpg) | Add to Reading ListSource URL: www.cms.govLanguage: English - Date: 2013-08-07 14:17:56
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45![HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND FOR ACTIVE EMPLOYEES FORMERLY UNDER THE HSTA VEBA BU 05, 45 EMPLOYER/EMPLOYEE CONTRIBUTIONS EFFECTIVE JULY 1, 2011 THROUGH JULY 31, 2011 HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND FOR ACTIVE EMPLOYEES FORMERLY UNDER THE HSTA VEBA BU 05, 45 EMPLOYER/EMPLOYEE CONTRIBUTIONS EFFECTIVE JULY 1, 2011 THROUGH JULY 31, 2011](https://www.pdfsearch.io/img/f7b076469987c7f3f5974619455de07f.jpg) | Add to Reading ListSource URL: files.hawaii.govLanguage: English - Date: 2013-01-24 16:44:10
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46![HSTA_VEBA_COBRA_Members_and_OE.pdf HSTA_VEBA_COBRA_Members_and_OE.pdf](https://www.pdfsearch.io/img/dc4591a0890211ce15a0f4cd876405f4.jpg) | Add to Reading ListSource URL: files.hawaii.gov- Date: 2013-01-24 16:43:14
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47![HSTA_VEBA_COBRA_Members_and_OE.pdf HSTA_VEBA_COBRA_Members_and_OE.pdf](https://www.pdfsearch.io/img/cfc51d8b5e332eb6676f169bcdbc0ba6.jpg) | Add to Reading ListSource URL: files.hawaii.gov- Date: 2013-01-24 16:43:14
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48![HSTA_VEBA_COBRA_Members_and_OE.pdf HSTA_VEBA_COBRA_Members_and_OE.pdf](https://www.pdfsearch.io/img/e97a504e60fa69799f0a33013458e8b5.jpg) | Add to Reading ListSource URL: files.hawaii.gov- Date: 2013-01-24 16:43:15
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49![HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND FOR ACTIVE EMPLOYEES FORMERLY UNDER THE HSTA VEBA BU 05, 45 EMPLOYER/EMPLOYEE CONTRIBUTIONS EFFECTIVE AUGUST 1, 2011 THROUGH DECEMBER 31, 2011 HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND FOR ACTIVE EMPLOYEES FORMERLY UNDER THE HSTA VEBA BU 05, 45 EMPLOYER/EMPLOYEE CONTRIBUTIONS EFFECTIVE AUGUST 1, 2011 THROUGH DECEMBER 31, 2011](https://www.pdfsearch.io/img/545a1716bbfc7907adefb7773760e297.jpg) | Add to Reading ListSource URL: files.hawaii.govLanguage: English - Date: 2013-01-24 16:44:11
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50![HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND FOR COBRA ACTIVE EMPLOYEES BU 05, 45 FORMERLY UNDER THE HSTA VEBA HSTA VB COBRA ACTIVE RATES EFFECTIVE JANUARY 1, 2012 Benefit Plan HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND FOR COBRA ACTIVE EMPLOYEES BU 05, 45 FORMERLY UNDER THE HSTA VEBA HSTA VB COBRA ACTIVE RATES EFFECTIVE JANUARY 1, 2012 Benefit Plan](https://www.pdfsearch.io/img/72ea181d68f26e5c81723348b0b4ca44.jpg) | Add to Reading ListSource URL: files.hawaii.govLanguage: English - Date: 2013-01-24 16:43:12
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