Northwest Ironworkers Trust Funds



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• Enrollment Forms
  • Authorization of Reciprocal Contributions Transfer
  • Change of Address Form
  • Enrollment/Beneficiary Form
• Claim Forms
  • Dental Claim Form (for Active Participants and Retirees Enrolled in the Dental Plan)
  • Medical/Rx Claim Form - For Active and COBRA, and Non-Medicare Retirees
  • Medical/Rx Claim Form - For Medicare Participants and Retirees
  • Elixir - Mail Order Form
  • Weekly Disability Benefits Claim Form
  • Vision Service Plan (VSP) Non-Network Claim Reimbursement Form
• Privacy and Disclosures
  • Authorization for Disclosure of Protected Health Information
  • Health & Security Trust - Notice of Privacy Practices
  • Revocation of Protected Health Information Disclosure