Documents and Forms
Documents
Forms
The below forms are here for your convenience. Please contact your Local Fund office first when submitting a claim or providing information.
About the Plans
Authorization to release PHI
General HIPPA Authorization
Health Care related Federal Laws
Mental Health Parity & Addiction Equity Act
Reimbursement
Medical Massage Therapy
Prescription drug
Life insurance
HIPPA
Residence Spouse as of a date
Financial Responsibility
Residence Dependent
Reimbursement third party agreement
Residence Spouse
Marital Status
Paternity
Travel Assistance
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