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Forms

Participant Data Form

This form should be used to update or correct your demographic information.

Online Form
Direct Deposit

Direct Deposit

Authorize direct deposit of reimbursement funds into your personal bank account.

Online Form

Claims

Submit a claim for a medical expense or premium reimbursement by registering for the online member portal. 

Download Form
Member Portal
Portfolio

Portfolio

Make your investment portfolio selection during open enrollment.

Download Form
Additional Documents

Need More Information?

Contact Us at (877) 808-5994

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Contact

Phone: (877) 808-5994
or (213) 406-2366
Fax: (562) 463-5894
Email: PORACRMT@bpabenefits.com

Mail Claims To

PORAC Retiree Medical Trust
c/o Benefit Programs Administration
1200 Wilshire Blvd 5th Floor
Los Angeles, CA 90017

Quick Links

  • Enrollment Application
  • Direct Deposit Form
  • Claim Form
  • Portfolio Selection Form
  • HIPAA Notice of Privacy Practices

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