Welfare Trust Fund Forms

⭐Trust Fund Benefits Graphic Organizer⭐

(Coverage amounts and details)

Reimbursement Forms: 

Defensive driving claim reimbursement form

Medical claim reimbursement form

Vision claim reimbursement form

Dental: 

*Our Guardian dental contract

Guardian dental claim form  

Find a Guardian provider

Dependent eligibility form

Enrollment form

Life Insurance:

 Life insurance enrollment form (Mutual of Omaha)

Retiree Life Insurance Policy

Accidental death and dismemberment certificate summary 

Vision:

Vision enrollment form