Upon enrollment and each year after that, you and each covered dependent must complete an Annual Coordination of Benefits Form so the Fund Office can determine coordination of benefits. You must provide up-to-date information before benefits may be processed.
The Participant must sign all forms. Each dependent age 18 or older must also sign the patient's line.
Annual Coordination of Benefits Forms must be submitted within 12 months from the date requested using this fillable Annual Coordination of Benefits Form. You can also get a copy from your Local Union. Return it to the Fund Office when properly completed.
TIP: Medical and prescription drug claims will not be paid until your properly completed form is received by the Fund Office. Submit your Annual Coordination of Benefits Form as early in the year as possible.