Documents and Forms

TitleCategoryView File
December 2016 Archived Newsletters Download
June 2016 Archived Newsletters Download
December 2015 Archived Newsletters Download
June 2015 Archived Newsletters Download
December 2014 Archived Newsletters Download
June 2014 Archived Newsletters Download
November 2013 Archived Newsletters Download
June 2013 Archived Newsletters Download
December 2012 Archived Newsletters Download
June 2012 Archived Newsletters Download
December 2011 Archived Newsletters Download
June 2011 Archived Newsletters Download
December 2010 Archived Newsletters Download
June 2010 Archived Newsletters Download
December 2009 Archived Newsletters Download
June 2009 Archived Newsletters Download
December 2008 Archived Newsletters Download
How to Complete an Electronic Data Card Data Card Download
Data Claim Statement - Data Card (fillable PDF) Data Card Download
Base Plan Summary Plan Description (SPD) Welfare Trust Fund SPD Download
Plan Document Welfare Trust Fund SPD Download
Amendment 1 Welfare Trust Fund SPD Download
Amendment 2 Welfare Trust Fund SPD Download
Amendment 3 Welfare Trust Fund SPD Download
Amendment 4 Welfare Trust Fund SPD Download
Amendment 5 Welfare Trust Fund SPD Download
Amendment 6 Welfare Trust Fund SPD Download
Amendment 7 Welfare Trust Fund SPD Download
Amendment 8 Welfare Trust Fund SPD Download
Alternative Plan Summary Plan Description 2015 Welfare Trust Fund SPD Download
Notice of Privacy Policy Welfare Trust Fund SPD Download
Customer Service Consent Welfare Trust Fund Forms Download
Spousal and Dependent Insurance Form Welfare Trust Fund Forms Download
Special Dependent Enrollment Form Welfare Trust Fund Forms Download
Specific Information Release Welfare Trust Fund Forms Download
Appeal Forms Welfare Trust Fund Forms Download
Other Insurance Welfare Trust Fund Forms Download
Contribution Rate effective June 1, 2017 Welfare Trust Fund Documents Download
Epic Hearing Service Plan Welfare Trust Fund Documents Download
Nondiscrimination Notice Section 1557 ACA Welfare Trust Fund Documents Download
Pension Plan Document Pension Trust Fund SPD Download
Privacy Policy Welfare Trust Fund Documents Download
Summary Plan Description 2013 Pension Trust Fund SPD Download
Pension Amendment 1 Pension Trust Fund SPD Download
Pension Amendment 2 Pension Trust Fund SPD Download
Pension Amendment 3 Pension Trust Fund SPD Download
Pension Amendment 4 Pension Trust Fund SPD Download
Pension Amendment 5 Pension Trust Fund SPD Download
Pension Amendment 6 Pension Trust Fund SPD Download
Pension Amendment 7 Pension Trust Fund SPD Download
Bargaining and Non-Bargaining Verification Pension Trust Fund Forms Download
Benefit Application and Certification Pension Trust Fund Forms Download
Waiver of Joint and Survivor Benefit Pension Trust Fund Forms Download
Advanced Determination Pension Trust Fund Forms Download
Maximum Benefit Test (Section 415 Limits) Form Pension Trust Fund Forms Download
Notice of Return to Work Pension Trust Fund Forms Download
Pension Application Only Pension Trust Fund Forms Download
Resumption of Benefits Pension Trust Fund Forms Download
2017 W-4P Pension Trust Fund Forms Download
Direct Deposit Form Pension Trust Fund Forms Download
Joint & Survivor Explanation Verification Form Pension Trust Fund Forms Download
Notice of Right to Defer and Consequences of Failure to Defer Pension Trust Fund Forms Download
Pension Annual Funding Notice Sept 2016 Pension Annual Funding Notices Download
Pension Annual Funding Notice Sept 2013 Pension Annual Funding Notices Download
Pension Annual Funding Notice Sept 2014 Pension Annual Funding Notices Download
Pension Annual Funding Notice 2015 Pension Annual Funding Notices Download
COBRA Notice Base Plan COBRA Download
COBRA Notice Alt Plan COBRA Download
COBRA Notice Single Alt Plan COBRA Download
Notification of Qualifying Event COBRA Download
Member Accident Form Accident Forms Download
Spouse Accident Form Accident Forms Download
Dependent Accident Form Accident Forms Download
Physician's Statement for Loss of Time from Work Accident Forms Download
Biometric Screening - Labcorp Voucher Instructions Wellness Power Download
Biometric Screening Form - Personal Physician Wellness Power Download
Subrogation Agreement and Loan Agreement Accident Forms Download
Benny Card Terms & Conditions HRA Documents Download
How to Login to the HRA Participant Portal HRA Documents Download
How To Use Your Benny Card HRA Documents Download
HRA Eligible Expense List HRA Documents Download
HRA Participant Portal User Guide HRA Documents Download
HRA Reimbursement Terms & Conditions HRA Documents Download
IRS Publication 502 HRA Documents Download
Uploading Documentation using the Mobile App HRA Documents Download
Use the Mobile App to Change Your Password HRA Documents Download
View HRA Account Activity HRA Documents Download
Health Reimbursement Arrangement (HRA) Account Claim for Reimbursement HRA Forms Download
HRA Direct Deposit Form HRA Forms Download
Supplemental Retirement Plan Summary Plan Description 2015 Retirees SPD Download
Application for Retiree Plan Retirees Forms Download
Authorization for Automatic Deposits Retirees Forms Download
Request Automatic HRA Reimbursement of Retiree Premium Retirees Forms Download
June 2017 Current Newsletter Download
Member Benefits - Create Account Instructions Member Benefits Download
Welfare Trust Agreement Employers Download
Welfare Trust Agreement Amendment Employers Download
Affordable Care Act’s Requirements Applicable to Large Contributing Employers Employers Download
How To Read Your EOB Explanation of Benefits Download
How to View Your eEOB Other Download
BCBS Blue Access for Members Other Download
Description of Participation Options Welfare Trust Fund - Employer Information Download
Informational Letter to Employers Welfare Trust Fund - Employer Information Download
Admin Rules Welfare Trust Fund - Employer Information Download
Health Plan Only Welfare Trust Fund - Employer Information Download
Health Plan and HRA Welfare Trust Fund - Employer Information Download
Working Owner Alumni Agreement Welfare Trust Fund - Employer Information Download
Non Construction BU Agreement Welfare Trust Fund - Employer Information Download
Waiver of Non-Bargaining Participation Welfare Trust Fund - Employer Information Download
Business Information Sheet Welfare Trust Fund - Employer Information Download
Informational Letter to Employers - Pension Pension Trust Fund - Employer Information Download
Waiver of Non-Bargaining Participation - Pension Pension Trust Fund - Employer Information Download
Description of Participation Options - Pension Pension Trust Fund - Employer Information Download
Admin Rules - Pension Pension Trust Fund - Employer Information Download
Working Owner Alumni Agreement - Pension Pension Trust Fund - Employer Information Download
NBU Agreement Percentage of Salary - Pension Pension Trust Fund - Employer Information Download
NBU Agreement - Pension Pension Trust Fund - Employer Information Download
Business Information Sheet Pension Trust Fund - Employer Information Download
SBC for Base Plan Summary of Benefits and Coverage (SBC) Download
SBC for Alternative Plan Summary of Benefits and Coverage (SBC) Download
SBC for Medicare Eligible Retirees Base Plan Summary of Benefits and Coverage (SBC) Download
SBC for Medicare Eligible Retirees Alternative Plan Summary of Benefits and Coverage (SBC) Download
SBC for Retirees under 65 Base Plan Summary of Benefits and Coverage (SBC) Download
SBC for Single Alternative Plan Summary of Benefits and Coverage (SBC) Download