Downloads

Annual Funding Notice (Pension & Annuity)

  1. Plan Year Ending April 2019 Annual Funding Notice
  2. Plan Year Ending April 2018 Annual Funding Notice

Health & Welfare

  1. 2020 ESI National Preferred Formulary List
  2. Summary of Benefits and Coverage 2019 - Class II
  3. Summary of Benefits and Coverage 2019 - Class I
  4. 2019 COB-Active
  5. Health & Welfare Federal Acts & Guidelines Notice
  6. Notice of COBRA Rights
  7. Helpful Contact Information
  8. Vision Benefit Direct Reimbursement Form
  9. Affordable Care Act Section 1557 Notice
  10. HRA Claim Form
  11. Spouse Employment Verification Form
  12. Maiden Name Form

HIPAA

  1. Notice of Privacy Practices

Retirement Funds

  1. 2019 Right to Receive Form
  2. 2019 COB-Retired
  3. Savings Plan Investment Options Change-March 28, 2017
  4. Tax Form for Monthly Annuity (W-4)
  5. Tax Form for Monthly Pension (W-4)

Standard Forms

  1. Benefit Fund 2020-2021 Calendar
  2. Dependent Care Reimbursement Form
  3. Benefit Fund Direct Deposit Form
  4. Request to Review Hours Discrepancies
  5. Reciprocal Form
  6. Change Contact Information Form
  7. Census and Beneficiary Designation Form

Summary Annual Report (Health & Welfare)

  1. Health & Welfare Plan Year Ending April 2018 - Summary Annual Report (SAR)
  2. Health and Welfare Plan Year Ending April 2017-Summary Annual Report (SAR)

Summary Annual Report (Savings Plan)

  1. Savings Plan Year Ending April 2018-Summary Annual Report (SAR)
  2. Savings Plan Year Ending April 2017-Summary Annual Report (SAR)

Summary of Material Modification (SMM) - Health & Welfare

  1. Class II Retiree Coverage SMM (1.1.20)
  2. Chiro, Acupuncture, Ortho, and Dental SMM (5.1.19)
  3. Temple Health Heart Scan SMM (7-1-18)
  4. Health & Welfare AmWell Telehealth SMM (11-21-17)
  5. Health & Welfare May 1, 2017 Class II Plan Changes SMM
  6. Health & Welfare May 1, 2017 Class I Coverage Plan Changes SMM
  7. Health & Welfare $0 Co-Pay for In-Network Physical / Occupational Therapy SMM (1-1-16)
  8. Health & Welfare Changes to Claims and Appeals Procedures SMM (5-1-14)
  9. Health & Welfare Cafeteria Plan Change SMM (1-1-17)
  10. Health & Welfare New Retiree Co-Payment SMM (1-1-17)

Summary of Material Modification (SMM) - Pension & Annuity

  1. Annuity Interest Credits SMM (5.1.18)
  2. Disability Eligibility SMM (5.1.19)
  3. Pension Accrual Rate SMM (5.1.18)
  4. Pension Accrual Rate and Annuity Interest Rate SMM (5.1.17)

Summary of Material Modification (SMM) - Savings Plan

  1. Hardship Withdrawal for Funeral Expenses SMM (5.1.19)

Summary Plan Description (SPD Documents)

  1. Carpenters' of Philadelphia & Vicinity Summary Plan Description-Savings Plan (January 2018)
  2. Carpenters' of Philadelphia & Vicinity Summary Plan Description-Pension and Annuity Plan (May 2017)
  3. Carpenters' of Philadelphia & Vicinity Summary Plan Description-Retiree (Class II)
  4. Carpenters' of Philadelphia & Vicinity Summary Plan Description-Retiree (Class I)
  5. Carpenters' of Philadelphia & Vicinity Summary Plan Description-Health & Welfare Plan