Forms and Documents

Enrollment

Enrollment

Medical/Dental Enrollment Form

2022 Benefits At A Glance

Dental

Dental

CA Dental Plan Details

CA Direct Compensation (DC) Fee Schedule

NV Dental Plan Details

NV Direct Compensation (DC) Fee Schedule

INO Dental Plan Details

INO Dental Fee Schedule

DPPO Fee Schedule LA, MS, AL, TX

Dental PPO Fee Schedule All Other States (except LA, MS, AL, TX)

Medical

Anthem Preferred Provider Organization (PPO) Medical Plan

Anthem Active Plan Summary of Benefits and Coverage (SBC)

Anthem Bronze Plan Summary of Benefits and Coverage (SBC)

Anthem Active Plan Schedule of Medical Benefits as of June 2021

Hearing Aid Rider

LiveHealth Online

Looking for a Doctor?

Express Scripts (ESI)

Express Scripts Home Delivery Order Form

Health

HIPAA

Appoint a Personal Representative for HIPAA

HIPAA Form to Revoke a Personal Representative

HIPAA Authorization Form

HIPAA Privacy Notice

HIPAA Revocation Form

Summary Annual Reports

2019 Health & Welfare Summary Annual Report

2017 Health & Welfare Summary Annual Report

2016 Health & Welfare Summary Annual Report

2015 Health & Welfare Summary Annual Report

2014 Health & Welfare Summary Annual Report

2013 Health & Welfare Summary Annual Report

2012 Health & Welfare Summary Annual Report

2011 Health & Welfare Summary Annual Report

General

General

Health and Welfare SPD

General

Disability Hours Claim Form

Health and Welfare SPD

Southwest Carpenters Reciprocity Form

Student Status Form

Surprise Billing Protections

Health Care Rights and Important Information

Beneficiary Forms by Individual Fund

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