Welfare Fund Important Notices

Form 1095-B Request (pdf)

Notice of Privacy Practices 12/23/2024 (pdf)

Summary of Material Reduction (pdf)

Summary of Material Modification (pdf)

COBRA Premium 2025 (pdf)

The Empire Blue Cross Price Comparison (pdf)

Transparency Rule (pdf)

Your Rights and Protections Against Surprise Medical Bills As of 01/01/2022 (pdf)

Notice of Privacy Practices 2023-2024 (pdf)

Glossary and Medical Terms (ACA) (pdf)

Outpatient Diagnostic Testing Warning (pdf)

NYS Paid Family Leave Notice 1/1/2024 (pdf)

Summary of Material Modification 1/1/22-Active Members (pdf)

Summary of Material Modification 1/1/22- Pre-Medicare Retired Members (pdf)

Summary of Material Modifications 2017 (pdf)

Summary of Material Modifications 2016 (pdf)

Summary of Benefits and Coverage (ACA) Effective : 01/01/2023 To 12/31/2023 (pdf)

Local 15 End of Year Letter to Active Members 2023 (pdf)

Local 15 End of Year Letter to Retirees 2023 (pdf)

Part D Notice of Non-Creditable Coverage Active Members 2022 (pdf)

Part D Notice of Non-Creditable Coverage Retired Members 2022 (pdf)

Mental Health-Sub. Abuse Summary of Material Modification (pdf)

Premium Standard Formulary Medications 1/1/2022 (pdf)