Benefit Plan Enrollment

The forms in this section are Adobe Acrobat Files. These are downloadable, printable publications containing full text and graphics. You will need to have the Adobe Reader installed to use these forms. If you do not have it, you can download it for free from  Adobe.

Please select a Plan below to view and print the appropriate Enrollment form. To enroll in a plan, you must first be a member of LRFA (or apply at the same time). If you are not currently a member of LRFA, please see our Membership section.

• F-1a : Mortuary Benefit Plan Application

• F-9a : Health Care Benefit Application

• F-40 : Supplemental Health Benefit Plan Application

• F-65a : Medicare Supplemental Benefit Plan Application

• F-102 : International Travel Plan Application or you can Enroll Online for this plan.

• F-101 : Emergency Benefit Plan For Visitors From Abroad Application

• F-50 : Prescription Drug Plan Application