Summary Plan Description is a booklet that describes all benefits provided by the
The Schedule of Benefits Grid is part of your Summary Plan Description. This pamphlet
is a quick reference of benefits that are provided to you through the plan.
If you miss work due to an illness or injury, a Short-Term Disability Form must
be completed. In order to claim Short-Term Disability benefits, you must be
eligible for Health & Welfare Benefits at the time of disability. Any injuries
or accidents related to work are not covered under Short-Term Disability and
must be filed under your employers Worker's Compensation.
An Accident Questionnaire must be completed if the Fund Office receives a claim
and the diagnosis could be related to an injury or accident. If you have
recently received a denied claim pending for accident information, please
complete this questionnaire and submit to the Fund Office for review.
If your smoking status has changed since your annual open enrollment, complete
this form and submit it to the Fund Office.
A Spousal Coverage Verification Form must be completed if you are adding a spouse
to your policy. If your spouse is unemployed or self employed, this form must be
notarized and submitted yearly.
Enrollment-Beneficiary Form will allow you to change your election, add/drop
spouse and/or dependent child(ren), change beneficiary or address.
HIPAA Privacy Information is a leaflet to review that explains the Fund's Privacy
This must be completed for anyone over the age of 18 to authorize a
representative to speak on their behalf.