Use this section to locate the required forms and resources associated with the Health & Welfare Fund. For best results first download the form to your PC and then open the form on your PC.

You will need to use Adobe Reader to view the files below.

Summary Plan Description

2010 Health & Welfare Plan Changes

2011 Health & Welfare Plan Changes

2015 Plan changes

2016 Plan Changes

2018 Plan Change Bulletin Spanish

2018 Plan change bulletin English

Summary Plan Description

Claims and Appeals Procedures 2018

Forms

Suboxone Authorization form

Vivitrol Prior Auth 2016

Fitness Reimbursement ENG & SPN

Additional Information Questionnaire / Cuestionario de Informacion Adicional

Application for Retirees Death Benefits

Change of Address – Cambio de Direccion

Authorization to Deduct COBRA or Self-Pay Premium

COBRA election form

Other Insurance Questionnaire

Beneficiary Designation Form

Letter to Contractors re: ACA

Prescription Drug Claim Form

MASSAGE THERAPY CLAIM FORM

Retiree Self-Pay Election Form Plan A

Retiree Self-Pay Election Form Plan B

short term disability (accident & sickness) application

Special Enrollment 19-26 – January 2014

Other Documents

Laborers’ Recovery Program_English

Laborers’ Recovery Program_Spanish

Laborers’ Recovery Program_Brazilian Portuguese

Laborers’ Recovery Program_Continental Portuguese

Smoking Cessation Flyer

Mass Laborers Plan A 2018 SBC

Mass Laborers Plan B 2018 SBC

2018 SBC Plan A Spanish

2018 SBC Plan B Spanish

Mass Laborers 2017 SBC Plan A

Mass Laborers 2017 SBC Plan A Spanish

Mass Laborers 2017 SBC Plan B

Mass Laborers SBC 2017 Plan B Spanish

Mass Laborers 2016 SBC Plan A

Plan A SBC 2016 Spanish

Mass Laborers Plan B SBC – 2016

Plan B SBC 2016 Spanish

Mass Laborers Plan A SBC – 2015

MA Laborers Health Fund – SBC  – Plan A SPN

Mass Laborers Plan B SBC – 2015

MA Laborers Health Fund – SBC  – Plan B SPN

2010 Summary Annual Report

2011 Summary Annual Report

2012 July to Dec Summary Annual Report

2012 Summary Annual Report

BCBSMA Travel Guide

Quick Look at Eligibility Rules