Praxair Incorporated

www.praxair.com

Health and Welfare

Pension

Additional Information

Dental Fee Schedule

 Pension Schedule (vested)

COBRA

Health and Welfare Plan Schedule

 Pension Schedule (non-vested)

Creditable Coverage

Retiree Dental Schedule (ZR)

Disqualifying Employment Rules

Retiree Plan Schedule (ZR)

Request new/additional insurance cards

Retiree Health Coverage Eligibility Rules

Health and Welfare Forms

Pension Forms

Retiree Health Coverage Premium

Change of Address Form

Beneficiary Designation

Change of Beneficiary Form

Contingent Annuitant Election Form

Coordination of Benefits Yearly Update

Early Vested Benefit Election/Rejection Form

Coordination of Benefits (Custodial Parent)

Early CA Survivor Benefit Election/Rejection Form

Dependent Form

Early Survivor Benefit Election/Rejection Form

Dependent Eligibility Certification Form

Dependent Form

Dependent SSN Request Form

Dependent Eligibility Certification Form

Disability Claim Form

Dependent SSN Request Form

Disability Continuance Form

Disability Claim Form

Enrollment Form

Disability Continuance Form

Injury Report

Enrollment Form

Marital/Divorce Status Form

Injury Report

Pre-existing Condition Form

Marital/Divorce Status Form

Rx Solutions Mail Order Form

Pre-existing Condition Form

Rx Solutions Reimbursement Form

Rx Solutions Mail Order Form

Retiree Insurance Verification Form

Rx Solutions Reimbursement Form

Student Verification Form

Retiree Insurance Verification Form

Student Verification Form