A Request for Benefits Claim Form must be completed on a per-claim basis and sent to the Administration Office. The forms are not available for on-line completion but may be printed and sent in. Altered documents are not accepted by the Plan. If you have any questions regarding the forms, contact the Administration Office at (907) 561-5119, or 1-800-325-6532, ext. 236
Request for Benefits Claim Form
Request for Benefits Form (pdf)
Each member using the Plan must complete and submit a Request for Benefits form, which must be signed by both the member and his/her attorney. In the case that you will be incurring subsequent charges, your attorney can retain a photocopy of both sides of the first claim for use in submitting any future billing on the same matter. This will allow the Administration Office to properly identify you and your Plan, and relate to any prior claims submitted for you. This form should be sent to the Administration Office with your attorney's first billing in each matter. Delays in forwarding your agreement could hinder the processing of your claim and create a potential for loss of benefits.
Certification of Domestic Partnership
The ASEA Legal Services Trust Fund provides legal service benefits to eligible members, their eligible dependents, and certain other designated beneficiaries. If the member has a domestic partner, as that term is defined in the current Plan Book, the member may be able to make legal services available to that person. Please review Part C, Section 4 (c) of the Plan Book before completing this form.
Invoices for Services
Invoices for services provided during the Plan year must be submitted for payment no later than (60) sixty days after the end of the Plan year. Since the Plan year ends June 30, all bills for services provided prior to July 1 must be received by the Administration Office no later than August 31. The Plan reserves the right to deny any claims submitted after these deadlines.
