Forms

If you are unable to print any of the forms below, contact Employee Benefits employeebenefits@wcaa.us and a form will be mailed to the address on file. Submit all completed forms to:

HR Employee Benefits
Wayne County Airport Authority
11050 Rogell Dr #602
Detroit, MI  48242

Change of Address Notification Form

Address changes are processed through WCAA Human Resources. Please print out the address change form and submit to HR Employee Benefits via email employeebenefits@wcaa.us, faxed to (734)955-5737, or send through US Mail to: 11050 Rogell Dr #602,Detroit, Michigan 48242. If a legal name change applies, provide a copy of the social security card issued with the new name, as well.

Optical Reimbursement Form

WCAA provides its Non-Actives and covered beneficiaries with vision benefits through an Optical Reimbursement Program. This program reimburses expenses incurred for prescription eyeglasses or contact lenses, prescription frames, and vision examinations rendered by a licensed optometrist, optician, or ophthalmologist within each benefit period. The current Benefit Period runs from December 1st of every odd year, through November 30th of every odd year.

The maximum reimbursement amount per eligible family member is specified in the current collective bargaining agreement (CBA). To receive reimbursement, submit this form along with an original, paid receipt specifically detailing the person receiving services, services rendered (or qualified items bought), and expenses incurred for each service/item. Without this information, reimbursements cannot be processed. A check will be mailed after the 1st pay period of the month to the address on file.

Retiree Optical Reimbursement Claim Form 2021-2023 Period

Enrollment/Change Form

For a qualifying family status change (marriage, adoption of a child, divorce, death, childbirth), after the enrollment period, you have 30 days to make a change to your coverage. Please provide supporting documentation for the change. If the 30 day window is missed, the next opportunity will be during the following open enrollment.

IMPORTANT: If a dependent is no longer eligible (i.e. ex‐spouse), you are responsible for paying 100% of the claims or premiums for any ineligible dependent remaining on the plan 30 days after the life event. In addition, dependents will lose their rights for continued coverage under COBRA.