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Active Health Plan Forms
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| General |
- Health and Welfare SPD - Summary Plan Description for the Active Health and Welfare Plan.
- Interplan Claims & Appeals Procedure - This gives general information on Interplan and the claims procedure.
- NMHC Mail Order Form - The Plan encourages you to obtain all maintenance medications via mail order using this form. Both you and the Plan save considerably by purchasing prescriptions this way.
- Kaiser Account Change Form - You must notify Kaiser immediately of any change in your family such as the birth of a child or marriage. Failure to submit this form to Kaiser within 30 days of a family change may result in no coverage for the person to be added until the next open enrollment period.
- Designation of Beneficiary Form - This Form is designed for Participants, not receiving a pension, who want to designate their beneficiary. Please complete this Form and return it to the Administrative Office if the Participant wants to update or designate his/her beneficiary.
- Enrollment Form - This form is needed at the time of initiating your coverage with the Fund. The form provider dependent information, as well as coordination of benefits information. This form only needs to be submitted if you are newly enrolled in the Fund.
- Notice of Open Enrollment - Active - There is an open enrollment that annually takes place in December for change of coverage effective January 1.
- Step Child Insurance Enrollment - Form confirming support of your children or step-children.
| Claim Forms |
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