General
Health & Welfare
Forms
Document
Description
In-Mail Request
Update
marital status, add a new spouse or dependent child, designate
a beneficiary and update mailing address.
Initially
choose, or change your current, hospital-medical plan option.
Initially
choose, or change your current, hospital-medical plan option.
Update
your mailing address.
Application
for extended eligibility due to absence from covered employment
because of a disability.
Start
or continue benefit coverage for a handicapped, dependent
child.
Establish
dependent coverage for a foster child or stepchild.
Application
form to extend benefit coverage for a dependent child who
is over 19 years of age and a student at an accredited educational
institution.
Authorization
for the Trust Funds to electronically send your Vacation
benefit checks to your designated financial institution.
Faster, convenient and more secure than mailing checks to
an address.
Death
Notification & Benefit Application Forms
Document
Description
In-Mail Request
Notify
the Fund Office of the participant’s (Cement Mason’s)
death (submitted by the spouse or beneficiary)
Notify
the Fund Office of the death of a spouse or dependent child
(form submitted by the participant)
Form
to enroll eligible Beneficiaries/Dependents, of a Deceased
Participant/Pensioner, in order to continue applicable Health
and Welfare Plan benefits.
Dental
Benefit Plan Information
Document
Description
In-Mail Request
Active
Dental Plan Pamphlet
Description
of dental benefits for Active Cement Masons and their dependents.
Retired
Dental Plan Pamphlet
Description
of dental benefits for Retired Cement Masons and their dependents.
DeltaPreferred
Option (DPO)
Pamphlet
describing a new optional dental benefits program for Active
and Retired Cement Masons and their dependents.
Application
form describing a new optional dental benefits program for
Active and Retired Cement Masons and their dependents.
Pharmacy
Benefits Plan Information
Document
Description
In-Mail Request
Pamphlet,
with enrollment form, describing a prescriptions-by-mail
service offered as part of the Pharmacy benefit.
Complete
and return this form when you have purchased a covered, prescribed
prescription drug at retail cost and are seeking reimbursement.
Vision
Benefits Plan Information
Document
Description
In-Mail Request
Description
of vision benefits for Cement Masons and their dependents.
Miscellaneous
Benefits & Trust Funds Information
Document
Description
In-Mail Request
News
and information about your benefits, Trust Funds administration
and a quarterly "Calendar of Events".
A
monthly informational bulletin for our valued participants –assisting
you in understanding your benefits.
Blue
Cross® of California's PPO Prudent Buyer Plan ® Directory
of Health Care Professionals & Institutions
Directory
of hospitals, physicians, ambulance services, ambulatory
surgery centers, mental health facilities, hospice providers,
home health agencies, home infusion therapy providers, laboratories,
medical products/service providers, skilled nursing facilities,
dialysis centers and ancillary medical providers participating
in the Blue Cross® Prudent Buyer Plan PPO network,
which is used to provide hospital-medical benefits to participants
covered under the Trust Fund's Managed Health Care Plan.
