Documents and Forms
Documents
About the Plans
Forms
The below forms are here for your convenience. Please contact your Local Fund office first when submitting a claim or providing information.
Authorization to release PHI
Health Care related Federal Laws
Life insurance
Travel Assistance
HIPPA
Local Health Services
Document & Information Check list
Complete Annual Information Request form
Address(you or your dependents) Birth ,Marriage,Death Certificate
Telephone Beneficiary designation
Family status (such as marriage) Divorce Decrees
Covered by other insurance Court Ordered Health Coverage
Claims payment may require:
How, When and Where an injury occurred
Information about other Insurance
Information about any action against Third Party
Reimbursement Agreement form
Claim filing limit is 2 years from date incurred
Request an appeal within 180 days from the claim denial