.  Medicare Part-D  .  HIPAA Privacy  .   


Forms
Our commonly requested forms are available to you via download or mail.
 


DOWNLOAD

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FORMS FOR ALL FUNDS
Enrollment Form
Change of Address Form

FORMS FOR HEALTH & WELFARE FUND
Claim Form
Dental Claims Form

Prescription Drug Claim Form Active
Prescription Drug Claim Form Pensioner
Weekly Disability
Physician's Supplementary Certificate ( Physicians Disability Progress Report )
HIPAA Authorization
HIPAA Cancellation
HIPAA Request for PHI
Student Break Eligibility

FORMS FOR RETIREMENT FUND
We are currently updating this section to better serve our participants. Please call the Fund Office for immediate assistance. We appreciate your patience
.

FORMS FOR VACATION & HOLIDAY FUND
Interim Withdrawal Form
Monthly Benefit Election Form

 

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