Forms that apply to all plans are listed in the table below. These forms can be printed from your computer. Once printed, they can be completed and mailed to the Administrative Office:
Benefit Programs Administration
1200 Wilshire Blvd. 5th Floor
Los Angeles, CA 90017
If you have any questions, please contact the Administrative Office at (888) 806-8942
Office Hours: 8:30 am – 4:30 pm, Monday through Friday
Closed on major holidays. There is an after-hour answering machine to leave a message on.
| ALL PLANS Forms | |
|---|---|
| Plan Selection Form |  |
| Kaiser Enrollment/Change Form | |
| DeltaCare USA Enrollment Form | |
| UnitedHealthcare (UHC) Enrollment Form (fillable) | |
| Union Labor Life Insurance Enrollment/Change Form | |
To Save the document on your computer, right click on , then select Save Target As (or Save Link As).
Disclaimer:
Health benefits are available only if your employer participants in the Welfare program by paying the proper contributions. If you are in doubt as to whether contributions are being made on your behalf, check with your employer or the Administrative Office.
Health benefits are available only if your employer participants in the Welfare program by paying the proper contributions. If you are in doubt as to whether contributions are being made on your behalf, check with your employer or the Administrative Office.