PENSION FORMS

Direct Deposit Form

Direct deposit automatically transfers your distribution to your financial institution.

Use this form only if you retired on or prior to December 31, 2007.

Debit Authorization Form

Direct deposit automatically transfers your distribution to your financial institution.

Use this form only if you retired on or after January 1, 2008.

Change of Beneficiary

Members can change the beneficiary with regards to their pension.

Member Change of Address Form

Member can notify the Fund's of a new address.

The forms are in PDF format. To download

Adobe Acrobat Reader for free, click the link below.

WELFARE FORMS

Member Update Form (Claim Form)

Each member must complete a member update form each calendar year.

Disability Claim Form (Weekly Income)

Members can use this form to file for weekly income benefits if you become disabled.

Prescription Drug Claim Form

Use this form to seek reimbursement on prescription drugs that you have paid out of your pocket.

LDI Mail Order Drug Claim Form

Mail order for long-term maintenance drugs. After you have gotten two consecutive

30-day fills of a prescription at a retail pharmacy you may begin to take advantage

of the mail-order program.

Notice of Privacy Practices

In compliance with HIPAA, this Notice describes your rights concerning your health information, and describes our practices related to your health information. Please take the time to review this Notice carefully.

Authorization To Release Health Information

One of the most significant effects of the new privacy laws is that the Welfare Fund may no longer discuss your health information (including eligibility information) with your family members without your specific written authorization. For example, without authorization, we will not be able to discuss your health information with your spouse. Please have each family member that is 18 years old and over complete an authorization.

Student Verification Form

The Trust now requires completion of a Student Verification Form by the member and a school representative. All eligibility rules are included on the top of the form. In addition, please refer to the FAQ's page for more on this topic.

Member Change of Address Form

Member can notify the Fund's of a new address.