Welfare Fund Forms and Links

Printable Claim Forms

• Dental Claim Form
• Vision Claim Form
• Hearing Claim Form
• Medical Reimbursement Form 2021

Fee Schedules

• Benefit Booklet Fee Schedule
• 2021-2022 Supplemental Coverage Rates
• 2021-2022 COBRA RATES

Open Enrollment

September is Open Enrollment Month for members to add eligible spouses and dependents to the Welfare Fund’s Supplemental Dental Coverage

Enrollment for September of 2021 begins Sept 1st and ends on Sept 28th. All forms and documentation must be received by this date.

• Supplemental Coverage Enrollment Form
• Enrollment Documentation Requirements
• Important Information for Dependent Coverage
• Domestic Partner Letter
• DENTAL OPEN ENROLLMENT 2020-2021

Benefit and Program Information

Summary Plan Description (SPD)
BENEFITS AT A GLANCE
Statement of Grandfathered Status
UNUM Life Insurance
Stacey Braun Financial Counseling Program
HIPPA

** EAP Program This program is being provided by the district