Forms

Complete & Print Forms - You can complete most of the forms listed below right on your computer before you print. Simply click on a field in the form and type in the appropriate information. Then print the completed form, sign and mail it to Carpenters Trusts. These printable forms are in PDF format. To read and print them, you need the free Adobe Reader (which is probably already installed in your system). Click here if you do not have Adobe Reader installed on your system.

Enrollment

Summary of Benefits and Coverage

Self Contribution Coverage

COBRA

Retiree Coverage

  • General Notice of Retiree Coverage Plan Rights — One of the more important decisions you will face when you retire is how best to maintain health care coverage for you and your family. The Carpenters Health and Security Plan has four options under which eligible retirees may obtain health care coverage after retirement. The information in this notice should help you decide which option is best for you and your family.
  • Notice to Decline Coverage Agreement — Use this form to decline coverage under the Carpenters Health and Security Plan – For Retired Carpenters.
  • Retiree Coverage Plan Application (Western and Central Washington) — If you qualify and would like to participate in the Carpenters Health and Security Plan of Western Washington – For Retired Carpenters (the Retiree Health Plan), you must complete this application and return it to the Trust Office. Your career hours are available on your quarterly benefit statement or contact Participant Services at the Trust Office.
  • Retiree Coverage Plan Application (Eastern Washington, Idaho, Montana, Wyoming) — If you qualify and would like to participate in the Carpenters Health and Security Plan of Western Washington – For Retired Carpenters (the Retiree Health Plan), you must complete this application and return it to the Trust Office.
  • Retiree Health Reimbursement Account Application — If you are retired and eligible for Retiree Coverage or COBRA, you may pay a portion of your monthly premium from your Retiree Health Reimbursement Account. Please complete this application and return it to Carpenters Trusts.

Claims