FORMS
Claims FormsRetiree and Cobra FormsEligibility and Other FormsEmployer FormsDocuments
- Enrollment Form
- Claim Form
- Disability Form
- Subro Agreement
- Subro Accident Form
- Death Benefit Claim Form
- Accidental Dismemberment Claim Form
- Affidavit of Survivorship Form
- Adult Student Dependent Status Form
- Authorization of Personal Representative Form
- HIPAA Authorization Form (for Local Union Representatives as Authorized Reps.)
- Reciprocity Transfer Authorization
- Identification Card Request Form
- PLAN DOCUMENT RESTATED 4/1/16
- SMM 08/2016
- SMM [PROBABLY AROUND 10/2016]
- GENERAL INFORMATION NOTICE 8/16
- COBRA – RETIREE OPTIONS – 2016
- 2020 ACTIVE SBC
- 2020 RETIREE B SBC
- 2020 RETIREE H SBC
- TRUST AGREEMENT RESTATED JULY 2005 AND TRUST AMENDMENT 1
- DELINQUENCY PROCEDURES
- RECIPROCAL TRANSFER AUTHORIZATION FORM
Information provided in this website is subject to occasional changes in Plan benefits and policies and is therefore not guaranteed. Please contact the Fund Office if you have questions concerning any of the information in this website.