Once you’re eligible for benefits, you are sent a welcome package that includes enrollment forms to complete and return to the Fund Office within 60 days of your initial eligibility date.  Note: If you don’t enroll by the 60-day deadline, your coverage may be delayed.

To enroll yourself and your eligible spouse or domestic partner and dependent children, you must send the Fund Office a properly completed Enrollment & Beneficiary Form along with the documents explained on the form. Processing will be delayed until all required documents are received. 

Enrollment Forms:

Inland Enrollment & Beneficiary Form (PDF)

ULLICO Life/AD&D Enrollment Beneficiary Form (PDF)

United HealthCare (HMO) Enrollment Form (PDF)

Delta Dental Enrollment & Change Form (PDF)

VSP Vision Enrollment Form (PDF)

Authorization to Disclose Protected Health Information Form (PDF)

REMINDER: Processing will be delayed until all required documents are properly completed and  received by the Fund Office. For enrollment questions, contact the Fund Office at (800) 595-7473 and follow the prompts for the Inland Refrigeration Trust Funds.

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