Forms And Documents

Files are in downloadable PDF format and require Adobe Reader.

Topic Form Name Description
Health & Welfare Annual Physical and Hearing Aid Claim Form
Health & Welfare Appointment of Personal Representative
Health & Welfare ASO Dental Claim Form
Health & Welfare Anthem Blue Cross Blue Shield Claim Form
Health & Welfare CarelonRx Mail Order Form
Health & Welfare CarelonRx Reimbursement Form
Health & Welfare Combined Capp Account Request Form
Health & Welfare Credit Card Authorization Form
Health & Welfare Davis Vision Out of Network Claim Form
Health & Welfare Dental Claim Form
Health & Welfare Dependent Election Form
Health & Welfare Designation of Beneficiary
Health & Welfare Medicare Waiver Form & Instructions
Health & Welfare Missing Contribution Form
Health & Welfare Plan A to Plan C Redirection Form
Health & Welfare Notice to Employers Regarding Compliance with ACA
Health & Welfare Employer Mandate ACA
Health & Welfare MetLife Disability Claim Form - Plan A Only
Health & Welfare MRP IRS Updated Regulations Notice
Health & Welfare Health & Welfare Plan C Eligibility Wheel
Health & Welfare MetLife - Participant Life Insurance Claim Form
Health & Welfare ACA Certification for MRP
Health & Welfare Davis Vision C3/C4 Discount Brochure
Health & Welfare MRP Claim Form with Guideline
Health & Welfare MRP Claims Direct Deposit Form
Health & Welfare Plan Updates to ABA Therapy and Disabled Dependent Children - June 2017
Health & Welfare Medical Reimbursement Program (MRP) Mileage Worksheet 2021
Health & Welfare Plan C - Medical Reimbursement Program (MRP) Reminder Notice
Health & Welfare Retiree-Only Medical Reimbursement Program (R-MRP) Annual Notice
Health & Welfare IATSE Relief Letter for Health & Welfare Participants affected by Hurricanes Harvey, Irma, or Maria
Health & Welfare HIPAA FAQs for Locals
Health & Welfare IATSE MRP/RMRP Guidebook - 2019
Health & Welfare CAPP Rate Notice for Quarter Beginning April 1, 2023
Health & Welfare Medical Reimbursement Program (MRP) Mileage Worksheet_1.1.2022-6.30.2022
Health & Welfare Medical Reimbursement Program (MRP) Mileage Worksheet_7.1.2022-12.31.2022
Health & Welfare Retiree Reimbursement Direct Deposit Form
Health & Welfare Your Rights and Protections Against Surprise Medical Bills
Health & Welfare Machine Readable Files
Health & Welfare Travel and Lodging Claim Form
Health & Welfare Medical Reimbursement Program (MRP) Mileage Worksheet 2023