Massachusetts Laborers' Benefit Funds: Health and Welfare fund

Forgot your password?Change your password

Use this section to locate the required forms and resources associated with the Health and Welfare Fund.

forms	summary plan description	other documents

ACCIDENT AND INJURY QUESTIONNAIRE Affidavit of Survivorship Application for Retirees Death Benefits Application for Total and Permanent Disability Attending Physician's Supplementary Statement Beneficiary Designation Form COBRA Continuation Election Form Dependent Enrollment Form 2009 Life Insurance Claim Form Notification of the Death of An Insured Prescription Drug Claim Form Primary Care Physician Enrollment Form Proof of Death Provider's (Green) Claim Form Self-Pay Retirees Medical Program Election Form	2010 Health and Welfare Plan Changes Summary plan description	2009 Summary Annual Report BCBSMA Travel Guide Quick Look At Eligibility Rules

This information is intended only to provide highlights of the plans. In the event of any inconsistency between the information on this Web site and the official plan document, the terms of the official plan document, as interpreted by the Board of Trustees in its sole discretion, will control. All examples and projections included on this Web site are not a guarantee of future benefits under the plans. The benefit amounts are estimates only, based on the stated assumptions and are subject to change.

The Massachusetts Laborers' Benefit Funds reserve the right to amend, modify, or terminate all or part of any plan at any time.