Forms

This page provides a description of and links to the National IAM Benefit Trust Fund forms for employers. Click the form titles in the table below to review or download copies.

FormDescription

Eligible Dependent Certification Form (PDF)

Eligible employees, who designate eligible dependents who are not biological children, or who have a different last name than the employee, must certify the dependent's eligibility for coverage by completing and submitting this form in addition to the Enrollment Form.

Employee Additions and Terminations Form (PDF)

Employers should use this form when reporting new employees who are enrolling into a Benefit Trust Fund health care plan. Also, use this form to modify enrollee information.

Employer Notice to Plan Administrator of COBRA Qualifying Event Form (PDF)

Employers should use this form to report a termination of an employee enrolled in a Benefit Trust Fund health care plan.

Enrollment Form (PDF)

Eligible employees may enroll in a National IAM Benefit Trust Fund health plan by completing and submitting this form. This form is also used to enroll eligible dependents. The Fund requires only one enrollment form for all benefit plans under which you and your eligible dependents may be covered (including medical, dental, vision, short-term disability, and life and accidental death and dismemberment benefits).

Waiting Periods for Coverage - Employer Acknowledgement Form

Employers may use this form to acknowledge waiting periods for coverage.

Waiver Form (PDF)

Eligible employees wishing to waive coverage must complete and submit this form.

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The Benefit Trust Fund has easy-to-complete forms for reporting enrollment and dependent eligibility.