Healthcare Forms

Link to Claim Information
(To Submit Electronically access via member login)

Enrollment For Adult Dependent Children

Beneficary Form (All Plans)

Out of Network Medical Provider Reimbursement

Spousal Coverage Verification

Healthcare Plan Information Sheet (New Members)

Healthcare Plan Information Sheet (Existing Members)

Authorization for Healthcare Plan

Subrogation Agreement

Other Insurance Questionnaire


Prescription Forms
Employer Services Forms

401k Deduction

Healthcare Participation Agreement

Internet Shop Report
(to receive a password to access this online report, call 763-493-8834)
Vision Forms

Safety Eyeware
Contact Benefits Office at (763) 493-8836

Disability Forms

Loss of Time

Loss of Time Update

Defined Contribution / 401(k) / Pension Forms
SUB Fund Forms

Application for SUB Benefits

Beneficary (All Plans)

Please call ahead of time to schedule an appointment with whom you need to see.

The Benefit Office receives the negotiated contributions sent to us by your contractors or other Locals. These contributions are
what determine your eligibility for Health and Welfare and Retirement benefits. Each quarter that you work, you will receive a
statement from the Benefit Office with your hours worked and contributions received. It is important that you keep your check
stubs to make sure that all of your contributions are being reported correctly. In the event of an error or question,
please call the Fund office.

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