Forms

Please Note:  In order to view and print most of the following documents, you must have the current version of Adobe Acrobat Reader installed on your computer.  If you are having trouble viewing these documents, you may need to download the Adobe Acrobat Reader Software or update your existing Acrobat Reader by clicking on the image below.

Supplemental Health & Welfare Fund Claim Form [1/2018 to 6/2018]

  • Use this form for the claims period of January 1, 2018 through June 31, 2018.  The form must be completed, signed and submitted to the Fund Office by August 31, 2018 in order to receive benefits in October 2018.
  • Supplemental Health & Welfare Fund Claim Form [7/2017 to 12/2017]

  • Use this form for the claims period of July 1, 2017 through December 31, 2017.  The form must be completed, signed and submitted to the Fund Office by February 28, 2018 in order to receive benefit in April 2018.
  • Boilermakers National Health and Welfare Fund Authorization For Release of Protected Health Information

  • Complete this form authorizing the Boilermakers National Health and Welfare Fund to release premium reimbursement information to the Boilermakers Local 83 Supplemental Health and Welfare Fund
  • Boilermakers National Pension Fund Authorization For Release of Protected Health Information

  • Complete this form authorizing the Boilermakers National Pension Fund to release work hours and contributions history to the Boilermakers Local 83 Supplemental Health and Welfare Fund.
  • Authorization For Release of Protected Health Information

  • Use this form to authorize the release of Protected Health Information, such as premium reimbursement information, from a carrier other than the Boilermakers National Health and Welfare Fund to the Boilermakers Local 83 Supplemental Health and Welfare Fund.