Downloads

Annual Funding Notice (Pension & Annuity)

  1. Pension & Annuity Plan Year Ending April 2018 - Annual Funding Notice
  2. Pension & Annuity Plan Year Ending April 2019 - Annual Funding Notice

Collections

  1. Dependent Care Reimbursement Form
  2. Benefit Fund Direct Deposit Form
  3. Request to Review Hours Discrepancies
  4. Reciprocal Form
  5. Change Contact Information Form

Health & Welfare

  1. 2020 ESI National Preferred Formulary List
  2. Benefit Fund 2020-2021 Calendar
  3. Summary of Benefits and Coverage 2020 - Class II
  4. Summary of Benefits and Coverage 2020 - Class I
  5. 2020 COB-Retired
  6. 2020 COB-Active
  7. Health & Welfare Federal Acts & Guidelines Notice
  8. Notice of COBRA Rights
  9. Helpful Contact Information
  10. Vision Benefit Direct Reimbursement Form
  11. Affordable Care Act Section 1557 Notice
  12. HRA Claim Form
  13. Benefit Fund Direct Deposit Form
  14. Spouse Employment Verification Form
  15. Maiden Name Form
  16. Change Contact Information Form
  17. Census and Beneficiary Designation Form

HIPAA

  1. Notice of Privacy Practices

Retirement Funds

  1. Benefit Fund 2020-2021 Calendar
  2. 2019 Right to Receive Form
  3. 2020 COB-Retired
  4. Benefit Fund Direct Deposit Form
  5. Tax Form for Monthly Annuity (W-4)
  6. Tax Form for Monthly Pension (W-4)
  7. Change Contact Information Form

Summary Annual Report (Health & Welfare)

  1. Health & Welfare Plan Year Ending April 2019 - Summary Annual Report (SAR)
  2. Health & Welfare Plan Year Ending April 2018 - Summary Annual Report (SAR)

Summary Annual Report (Savings Plan)

  1. Savings Plan Year Ending April 2019 - Summary Annual Report (SAR)
  2. Savings Plan Year Ending April 2018-Summary Annual Report (SAR)

Summary Plan Description (SPD Documents)

  1. Aetna Medicare Advantage Plan-Explanation of Coverage (2020)
  2. Carpenters of Philadelphia & Vicinity Summary Plan Description-Savings Plan (May 2020)
  3. Carpenters of Philadelphia & Vicinity Summary Plan Description-Pension and Annuity Plan (May 2020)
  4. Independence Administrators Benefit Booklet (Class II)
  5. Independence Administrators Benefit Booklet (Class I)
  6. Carpenters of Philadelphia & Vicinity Summary Plan Description-Health & Welfare Plan (May 2020)