Welcome to the Welfare Fund Forms Section

HRA Claim Form

Please note that HRA benefits are paid by the Fund on a monthly basis. To ensure timely payment of each claim submission completed claim forms must be submitted to the Fund Office no later than the second Tuesday of each calendar month.

Change of Address Form

Beneficiary Designation Form

Special Enrollment Form (Adult Child to Age 26)

Benefit Enrollment Form

Universal Enrollment Form

PHI Authorization Form

PHI Cancellation Form

Weekly Unemployment Benefit Form - NEW

Certification of Medical Necessity Form

Qualified Relative Certification Form

Dental Claim Form Out-of-Network

Vision Claim Form Out-of-Network

Hearing Aid Claim Form

Medicare Claim Form

Notarized Affidavit of Current Marriage

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