Downloads

Annual Funding Notice

  1. Plan Year Ending April 2017 Annual Funding Notice

H&W Summary of Material Modification (SMM)

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

Health & Welfare

  1. 2018 ESI National Preferred Formulary List
  2. 2019 COB-Active
  3. Affordable Care Act Section 1557 Notice
  4. Health & Welfare Federal Acts & Guidelines Notice
  5. Helpful Contact Information
  6. HRA Claim Form
  7. Maiden Name Form
  8. Notice of COBRA Rights
  9. Spouse Employment Verification Form
  10. Summary of Benefits and Coverage 2019 - Class I
  11. Summary of Benefits and Coverage 2019 - Class II
  12. Vision Benefit Direct Reimbursement Form

HIPAA

  1. Notice of Privacy Practices

Pension & Annuity Summary of Material Modification (SMM)

  1. Pension Accrual Rate and Annuity Interest Rate SMM (5.1.17)
  2. Pension Accrual Rate SMM (5.1.18)

Retirement Funds

  1. 2018 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 Direct Deposit Form
  2. Census and Beneficiary Designation Form
  3. Change Contact Information Form
  4. Dependent Care Reimbursement Form
  5. Reciprocal Form
  6. Request to Review Hours Discrepancies

Summary Annual Reports

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

Summary Plan Description (SPD Documents)

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