Downloads

Annual Funding Notice (Pension & Annuity)

  1. Pension & Annuity Plan Year Ending April 2019 - Annual Funding Notice
  2. Pension & Annuity Plan Year Ending April 2020 - Annual Funding Notice

Collections

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

Health & Welfare

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

HIPAA

  1. Notice of Privacy Practices

Medicare

  1. Blue Medicare Advantage Plan - Evidence of Coverage (2021)

Retirement Funds

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

Summary Annual Report (Health & Welfare)

  1. Health & Welfare Plan Year Ending April 2019 - Summary Annual Report (SAR)
  2. Health & Welfare Plan Year Ending April 2020 - 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 2020 - Summary Annual Report (SAR)

Summary Plan Description (SPD Documents)

  1. Carpenters Health & Welfare Plan (May 2020)- Summary Plan Description
  2. Carpenters Pension and Annuity Plan (May 2020) - Summary Plan Description
  3. Carpenters Retiree Health & Welfare Coverage (Jan 2021) - Summary Plan Description
  4. Carpenters Savings Plan (May 2020) - Summary Plan Description
  5. Independence Administrators Benefit Booklet (Basic Coverage)
  6. Independence Administrators Benefit Booklet (Full Coverage)