Short-Term Disability (STD) Plan Forms

This page provides a description of and links to National IAM Benefit Trust Fund forms related to the Fund’s STD plans. Click the form titles in the table below to review or download copies.

FormDescription

Enrollment Form (PDF)

Eligible employees may enroll in a National IAM Benefit Trust Fund STD plan by completing and submitting this form. A Benefit Trust Fund short-term disability plan must be negotiated into a CBA, and the eligible employee must also enroll in an associated Benefit Trust Fund medical plan, in order to enroll in a Fund STD plan.

Short-Term Disability Claim Form (PDF)

To submit a disability claim, have a Short-Term Disability Claim Form completed by your employer, yourself, and your physician. Send your completed claim form to the Fund Office for processing.

Waiver Form (PDF)

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

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Send your completed claim form to the Fund Office for processing.

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.

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