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Health Plan

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Forms & Publications

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Contact Us

ERISA Rights

 


 

 
9801 West Higgins Road #500
Rosemont IL 60018-4740
847-384-7000
800-621-5133
General FAX 847-384-0197

Billing Office
    ext 7030
    FAX 847-384-0197
Claims/Rx Customer Service
    ext 7180
    FAX 847-384-0196
Health Information Services
    ext 7050
    FAX 847-384-0198
Pension Office
    ext 7070
    FAX 847-384-0197

Forms & Publications

Downloadable Forms

Several forms are available in PDF format for downloading and printing. Click the Health or Pension links below to see a list of available forms.

  • Health Forms & Publications
  • Pension Forms & Publications

You will need Adobe Acrobat® Reader to view forms online.
 

Request Forms to be Sent by Mail

If you do not see the form you need in Downloadable Forms, or if you would like to request that we send forms to you through the U.S. Postal Service, contact the Benefits Fund Office. You may call for forms 24 hours a day.
 

(Updated 10/02/17)

(c) 2018 UFCW Midwest