Life/AD&D Plan Forms

This page provides a description of and links to National IAM Benefit Trust Fund forms related to the Fund life and AD&D plan. Click the form titles in the table below to review or download copies.

FormDescription

Enrollment Form (PDF)

Eligible members may enroll in a National IAM Benefit Trust Fund life and AD&D plan by completing and submitting this form. This form is also used to designate beneficiaries.

Waiver Form (PDF)

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

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Please be sure to list your beneficiary (including primary and secondary beneficiaries, if applicable) when enrolling in a life and AD&D plan.

Frequently Asked Question (FAQ)

How many different plans does the Fund offer?

The Fund offers multiple Medical, Dental, and Vision plans. Short-Term Disability and Life and Accidental Death & Dismemberment benefits are also available.

How do I notify the Fund of my address change?

If you move, please notify the Fund of your new address. To change your address,
fill out a new Enrollment Form and mail or fax it to the Fund using the mailing address or fax number found on the form. Always complete a new Enrollment Form when you have a change in personal information.

How often are rates subject to change?

All Plans are reviewed annually; notification of rate changes is provided 30-60 days in advance of the renewal effective date.

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