September 2023
ATTENTION MEMBERS:
The IBEW 292 Benefits Office has recently mailed out the 2024 calendar year Annual Health Care Enrollment Forms to all Active Members covered under the I.B.E.W. 292 Health Care Plan. These forms are also available under the FORMS tab at https://www.ibew292benefits.org/forms/
All completed forms need to be received by IBEW 292 Benefits Office by November 17, 2023.
These forms MUST be completed to ensure the continuation of Health Care coverage as of January 1, 2024, for ACTIVE participants and your dependents of the I.B.E.W. 292 Health Care Plan. This applies to ACTIVE members, not Retirees.
Forms include:
I.B.E.W 292 Health Care Plan Information Sheet – Mandatory to complete and return.
Spousal Coverage Verification Form – Mandatory to complete and return for spousal coverage.
Adult Dependent Enrollment Application – Mandatory to complete and return for all dependent children between the age of 19 and up to 26.
Authorization for Release of Health Information Form – Optional to complete and return.
All completed forms need to be received by IBEW 292 Benefits Office by November 17, 2023. Please call the IBEW 292 Benefits Office if you have any questions. 763-493-8830
Mail to:
IBEW 292 Benefits Office 6900 Wedgwood Rd N ste 425
Maple Grove, MN 55311
Email to: enrollment@ibew292benefits.org
Fax to: 763-416-6196
