Health and Welfare Fund Forms

Accident Form

Appeal Form - H&W

 Dependent Insurance Verification Form

Disability Form *NEW - Effective June 13, 2024* 2 pages

Enrollment Form

 Family Medical Leave (FMLA) and Bereavement Form

Standard Medical Form

Special Fund Payment Request Form

Special Fund Direct Deposit Form

Multi-Fund Forms

Change of Address

Beneficiary Designation Form

• The Beneficiary Designation form is tied to both the Health and Welfare as well as the Pension Fund.  You must complete both sections in order to update regardless of if you are only updating the beneficiary for one of the funds.