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Forms To Download

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Physical Well-Being Fitness Reimbursement Form

Physical Well-Being Benefit Direct Reimbursement Form

Weekly Group Accident & Sickness
Disability Insurance Claim Form

Prescription Incentive Program Claim Form

Dental Change Request form

Dental Benefits Program

Flexible Benefits Plan Claim Form

2004 Other Prescription Drug Benefit information

Request for Change of Address

FT Student Verification Form

Salary Deferral Agreement/Change Form

Declaration of Spouse Health Coverage

Website Claim Form Download Disclaimer

The ability to download these forms does not guarantee your entitlement to benefits or benefit payment.
The benefits that each participant is entitled to receive are determined by the collective bargaining agreement between the Union and your contributing employer.
If you submit a form for a benefit for which you are not entitled, you will be notified that your form could not be processed and it will state the reason. Questions concerning your eligibility for benefits should be directed to the Fund office or refer to your Summary Plan Description booklet.