All the documents and forms below are in PDF format, which can be viewed, downloaded and printed from virtually any computer or mobile device. Note that many of the PDF forms can be filled out electronically before printing for your convenience. If you cannot access or print a form or document, send us an e-mail request and we'll be glad to mail a printed copy to your home address.
For some forms, you may need to provide additional documentation, such as a provider's receipt, additional claim form, or a marriage or birth certificate.
If you fill out the Dependent Addition Request Form, you must enclose:
Please note:
Once you complete the Form, print it out and send the required documentation to the Fund Office.
When you complete, print, and sign a form, you can either scan and email or mail the form (and any required documentation, if necessary) to the Fund Office.
Beneficiary Designation Form [pdf .18 MB]
Dental Claim Form [pdf .75 MB]
Express Scripts Claim Form [pdf .07 MB]
Request for Retiree Eligibility Form [pdf .54 MB]
Disability Claim Form [pdf .21 MB]
Reciprocity Election Form [pdf .36 MB]
Dependent Addition Request Form [pdf .3 MB]
© Iron Workers Tri-State Welfare Fund. The information on this Web site presents selected highlights of the Iron Workers Tri-State Welfare Fund. The actual Plan provisions of the Plan are in the Plan’s legal document. In the event of a conflict between the wording on the site and the legal documents, the legal documents will govern. The Trustees reserve the right to amend, modify, or discontinue all or part of the Plan at any time.