Your Forms:
+ Personal Information
- Membership Form
- Affidavit – If you cannot locate the marriage certificate or birth certificate(s), you can submit this affidavit in its place. The affidavit must be notarized.
+ Employee Assistance Program
The WorkLife Matters Employee Assistance Program offers services to help promote well-being and enhance the quality of life for you and your family. View details.
Connect to a counselor for free support services: 1-800-386-7055 (available 24 hours a day, 7 days a week).
Visit ibhworklife.com and login to “For Employees & Members” (password: wlm70101).
+ Disability
Disability means you are unable to work as a result of accidental bodily injuries, sickness or pregnancy that prevents you from performing your duties and are under the care of a legally licensed provider.
- Short-Term Disability Claim Form
- On the (8th) eighth day of a non-occupational disability, you quality for Short-Term Disability.
- The maximum benefit payable is 70% of your weekly salary, up to $875 per week, for up to 26 weeks.
- For complete guidelines, contact the Benefits Office if you are going on disability leave.
- Long-Term Disability Claim Form
- If your disability is longer than 26 continuous weeks, you may qualify for Long-Term Disability (LTD).
- The LTD plan pays you $3500 per month.
- Contact Rivetti Financial to continue your disability coverage without any medical screening.
+ Education
Participants are eligible for up to $3,000 in reimbursement per plan year (July 1-June 30) to cover expenses related to attend a U.S. patient safety event. You must submit at least 6 weeks prior to the conference date.
- QI Training & Education Application
- QI Training & Education Reimbursement Form (For those who have been previously approved for this benefit)
+ Mental Health Resources
- CA Mental Health Suicide Prevention Resources
- California Mental Health Hotline: 866-903-3787
- CA Peer-Run Warm Line: 855-845-7415
Attention: In compliance with HIPAA regulations, we are using a secure email portal. Please use benefits@cirseiu.org to send secure emails to the Benefits Office.







