Complete & Print Forms - You can complete most of the forms listed below right on your computer before you print. Simply click on a field in the form and type in the appropriate information. Then print the completed form, sign and mail it to the Trust Funds Office.
Change of Address - Use this form to change your address. Be sure to fill it out completely and return it to the Trust Office. (English Version)
Forma Para Solicitar Cambio De Dirección (En Español) - Use esta forma para hacer un cambio de dirección postal. Asegúrese de completer todos los espacios en la forma, y de enviar la misma a la oficina del Trust Funds.
HIPAA Participant Authorization Form - Use this form to instruct the Fund Office to communicate with you at an alternate address regarding your eligibility, carrier changes, etc.
HIPAA Special Enrollment (Retiree Only) - Use this form to DECLINE. An eligible retiree or spouse may decline initial enrollment in the RHP in the event the retiree or spouse may decline initial enrollment in the Retiree Health Plan in the event the retiree or spouse is declining initial enrollment due to other coverage. Please review and contact the Fund Office for assistance.
HIPAA Special Enrollment (Retiree Only) - Use this form to ENROLL during the HIPAA Special Enrollment (only if you or your spouse declined initial enrollment due to other coverage. Please review and contact the Fund Office for assistance.
Retiree Health Plan Application (Retiree Only) - Use this application to apply for health coverage during retirement. A determination on eligibility will be made following receipt by the Fund Office of the completed application.
Kaiser Permanente/Senior Advantage Election Form (Retiree Only) - If the retiree or eligible spouse selects one of the HMO medical Plans for health coverage and is eligible for Medicare, he or she must assign the Medicare benefits to the HMO Medicare-risk Plan that the retiree or spouse selects. Please contact the Trust Funds Office to obtain the enrollment form for Kaiser Permanente - Senior Advantage.
PacifiCare /Secure Horizons Enrollment Form (Retiree Only) - If the retiree or eligible spouse selects one of the HMO medical Plans for health coverage and is eligible for Medicare, he or she must assign the Medicare benefits to the HMO Medicare-risk Plan that the retiree or spouse selects. Please contact the Trust Funds Office to obtain the enrollment form for Secure Horizons/United Health care.
Legally Required
Summary Annual Report - This describes the status of the fund at the end of Plan Year 2007.
Summary Annual Report - This describes the status of the fund at the end of Plan Year 2006.