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.)

Retiree Election Form
Direct Payment Form
Termination of Direct Payment Form
Spouse Delayed Election Form
COBRA Election Form & Notice

Reciprocity Transfer Authorization
Identification Card Request Form

Construction Employer Contribution Form
Non Construction Employer Contribution Form

PLAN DOCUMENT RESTATED 4/1/16
SMM 08/2016
SMM [PROBABLY AROUND 10/2016]
GENERAL INFORMATION NOTICE 8/16
COBRA – RETIREE OPTIONS – 2016
2017 ACTIVE SBC
2017 RETIREE B SBC
2017 RETIREE H SBC
TRUST AGREEMENT RESTATED JULY 2005 AND TRUST AMENDMENT 1
DELINQUENCY PROCEDURES

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.