| Health and Welfare Vital Form with Beneficiary Designation |
|
|
|
Please complete this form if you qualify for insurance through the IBEW Local 17 Health and Welfare Fund. This is a two-sided document. You may return this completed form directly to the Health and Welfare office via email. Send the completed form with copies of your marriage license and birth certificates, if applicable, to enrollmentdocs@benesys.com and be sure to include one of our IBEW Benefit Specialists on the correspondence (see below).
Download:  Health and Welfare Fund Vital Form.pdf
|
|
| |
