top of page

Welfare (Active Participants)

At Local 7, we understand the importance of providing our members with easy access to their Welfare (Active Participants) information. That's why we have compiled all the necessary forms and documentation in one convenient place. Simply browse through our selection to find the information you need.

SPD/Forms

*Welfare - Summary Plan Description

Asbestos Screening Form

Authorization for Release of Health Information

CDPHP Enrollment Form

Claim Reimbursement Form

Dental Out-of-Network Member Claim Form

Express Scripts Commercial Claim Form

Letter of Medical Necessity Template

Loss of Time Benefits Form

Medical Out-of-network Member Claim Form

Notice of Privacy Practices Form

Waiver of Coverage Form

© 2035 by CSI, Inc.

bottom of page