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1

Each covered “employee” must have a current Enrollment Application on file. If you have not filled out and returned an Enrollment Application to the Plan Administrative Office, you cannot receive any benefits. In addition, you must have completed the applications for the specific providers you have chosen. An Enrollment Application is included in your information packet. Additional Enrollment Applications can be obtained from the Plan Administrative Office.

2

You must report any changes in your address or dependents to the Plan Administrative Office within thirty (30) days.

3

A Self-Directed Enrollment is available to plan participants. This allows you the option to change your medical and or dental providers at any time during the year in accordance with certain guidelines. They are as follows:

  • Plan participants can change medical providers one time within a twelve (12) month period.
  • Plan participants can change dental providers one time within a twelve (12) month period.

If your Employer offers more than one provider choice for medical or dental benefits, please see your Human Resources Department for more information.

4

Complete the Enrollment Application and return it to the Plan Administrative Office. You must also report any changes in your address or dependents to the Plan Administrative Office. An Enrollment Application is included in your information packet; additional Enrollment Applications can be obtained from the Plan Administrative Office or from your Local Union.

Please note that if you are in the process of enrolling a dependent under your health and welfare plan, and the dependent has a different last name than your own, you will need to provide proof of the dependent’s eligibility through submission of a copy of the appropriate, certified

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documents (i.e., a marriage certificate for a spouse/birth certificate for a child).

 

The importance of having your current address on file cannot be overstated! It is the only way the Board of Trustees can keep you informed of any changes affecting your benefits.