Welfare Fund Downloadable Forms
| Form Name |
PDF Downloads
|
Excel Download
|
| Accident Form |
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|
|
Adult Child
Enrollment Form (ages 18 through 25) |
|
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| Beneficiary Designation Form |
|
|
| Coordination of Benefits Form (COB) |
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|
| Dental Form |
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| Enrollment Form |
|
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| EyeMed Form |
|
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| Former Local 422 Participants Only HRA Claim Form |
|
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| Medco Mail Order |
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| Medco COB/Direct Claim Form |
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| Wellness Postcard |
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| Weekly Accident and Sickness Initial Form |
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| Weekly Accident and Sickness - Supplementary Statement |
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Benefit Funds Home
|
Retirement Fund |
Welfare Fund |
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Any
information that is contained on this web site as it relates to the
Welfare Fund, Retirement Fund,
Training Fund or the Individual Account and 401(k) Plan; is supplied for informational purposes
only and does not
amend,
replace or constitute your summary plan description or plan documents
for each of those funds or plans.