Obtain a Life AD-D Enrollment Form

Enrollment Required for Coverage to be Effective

When a National IAM Benefit Trust Fund life and AD&D plan is negotiated into a collective bargaining agreement, eligible employees must request and submit a completed Enrollment Form to be covered under the plan. This Enrollment Form is the same one you must submit to be covered under a Benefit Trust Fund medical plan. To enroll in a Benefit Trust Fund life and AD&D plan, members must be enrolled in a Benefit Trust Fund medical plan.

When completing the Enrollment Form to enroll in a life and AD&D plan, if available, please be sure to list your beneficiary (including primary and secondary beneficiaries, if applicable). If you do not designate a beneficiary, benefits will be paid to your spouse. If you do not have a spouse, benefits will be paid in the following order: to your children, your parents, your siblings or your estate.

The Fund requires only one enrollment form for all benefit plans under which you and your eligible dependents may be covered (including medical, dental, vision, short-term disability, and life and accidental death and dismemberment benefits). Please use one form for all plans in which you have the opportunity to enroll.

Waiving Coverage

If you pay all or part of the cost to be covered under a health, the Benefit Trust Fund will allow you to waive that coverage. However, choosing to waive medical coverage does not depend on waiving other coverage. You may waive medical coverage separately and keep your other coverage. You may also keep medical coverage only and waive other coverage, or you may waive all coverage completely. You may not waive any coverage that is fully employer-paid.

To waive coverage, you must submit a completed Waiver Form to the Fund Office. You should also send a copy of the Waiver Form to your employer to prevent your employer from making any unnecessary payroll deductions.

If you choose to waive coverage, the waiver will apply for the duration of the current collective bargaining agreement. However, if you waive coverage because you have coverage under another plan and you later lose that coverage due to unforeseen circumstances, you may submit a petition for special enrollment. To submit a petition for special enrollment, you must send the Fund Office a letter explaining your circumstances. The written request for special enrollment, along with a completed Enrollment Form, must be submitted to the Fund Office within thirty days of the date you lose coverage under the other plan.

Mail or fax completed forms to the Fund Office:

After Enrollment Forms are processed for a new group, the Fund Office will send participants a packet that provides information about their coverage.

An Enrollment Form should also be completed whenever you want to update the Fund about personal information changes or have a qualifying event. Examples of personal information changes or qualifying events include your change in address, getting married or divorced, adding or deleting a dependent, or changing your beneficiary information.

Whenever you complete an enrollment form, be sure to send a copy of the form to your employer to ensure that the appropriate contributions are made for the coverage you select.