B&C Trust Funds

Standard Funds Documents:

Participant Enrollment Form

Participant Change of Information Form

Health Benefit Documents:

Health Benefits Agreement & Declaration of Trust

UniCare MedicareRX Rewards Evidence of Coverage Booklet

UniCare MedicareRx Rewards Formulary Booklet

State Health Insurance Assistance Program Contact Listing

W-1 Summary Plan Description and Rules & Regulations

Retiree Enrollment Form for W-1 Benefits

P-Plan Summary Plan Description and Rules and Regulations

P-Plan Beneficiary Designation Form

P-Plan Claim Form

HIPAA Privacy Notice

Pension Benefit Documents:

Pension Fund Agreement & Declaration of Trust

Pension Fund Rehabilitation Plan

Pension Application Form

Pension Evaluation Form

Pension Summary Plan Description and Rules & Regulations as of January 2010 (Version P-6123-10)

Pension Summary Plan Description and Rules & Regulations as of June 2013 (Version P-6123-11)

Pension Beneficiary Designation Form

Pension Direct Deposit Authorization Form

Pension Medical Examination Form

Joint and Survivor Rejection Form

Change of Address Form

Federal IRS Documents:

Federal IRS Form W-4P

Federal IRS Form W-9

Standard Collective Bargaining Clause Documents:

Health Benefits SCBC Daily

Health Benefits SCBC Hourly

Health Benefits SCBC Monthly

Pension SCBC Hourly

Pension SCBC Daily

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