ATTENTION:
The Welfare Fund will no longer accept
the
old two-sided
Short Term Disability Form. Please
find the new form on the forms page or
click here.
Attention All Local 701 Member working
at employers that provide your Medical
Insurance Benefits
The Welfare Fund Office has recently
requested information regarding social
security numbers from every member who
has Medical Benefits through the Fund
and who has dependents- spouses are
dependents under the Plan.
This information is required by Federal
Law and must be completed including full
names, social security numbers, and
birthdates of everyone in your family.
The form also must be signed at the
bottom.
This is the final notice of this
mailing. BENEFITS WILL BE SUSPENDED
ON SEPTEMBER 15, 2009 IF THE COMPLETED
FORM IS NOT RECEIVED BY THE FUND OFFICE.
You have the option of mailing the
form, bringing in the form, faxing the
form to 708-482-4242, or emailing the
form to
cms@mech701-benefits.org
If you have any questions, please feel
free to contact the Welfare Fund at
(708) 482-0110.
Thank You for your cooperation in this
matter.
CMS Form
