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IUPAT Local 177 Welfare Trust Fund

Benefit Booklet Version 2019
Change of Address Form Version 1.0
Dental Claim Form Version 1.0
Electronic Funds Transfer Authorization for Claim Payment Version 1.0
Guide to Applying for Weekly Disability Benefits Version 1.0
Guide to Freezing of Hours Version 1.0
Over Age Dependent Coverage Form Version 1.0
Prescription Drug Claim Form Version 1.0
Registration/Change Form Version 1.0
Request for Freezing of Hours Version 1.0
Self-Payment Pre-Authorized Debit (PAD) Agreement Version 1.0
Special Authorization Drugs and Approval Guidelines Version 2019
Supplementary Health Claim Form Version 1.0
Vision Claim Form Version 1.0
Weekly Disability Benefits Statement Version 2019
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