This page provides a description of and links to National IAM Benefit Trust Fund forms related to Fund vision plans. Click the form titles below to review or download copies.

Enrollment Form

Enrollment Form (PDF)

Disabled Dependent Certification Form

Disabled Dependent Certification Form (PDF)

Eligible Dependent Certification Form

Eligible Dependent Certification Form (PDF)

Waiver Form

Waiver Form (PDF)

EyeMed Out of Network Form

Out of Network Form (PDF)

EyeMed Out of Network Instructions

Out of Network Instructions (PDF)

EyeMed Online Options

EyeMed Online Options (PDF)

 

Questions?

You can contact the IAM Benefit Trust Fund Office or your benefits provider directly to get more information about each plan.

  • Phone: 800-457-3481 or 202-785-8148. Our phones are open Monday through Friday, 8:30 AM to 4:00 PM Eastern Time.
  • Fax: 202-728-0585
  • Mail: National IAM Benefit Trust Fund, 99 M Street, SE,  Suite 600, Washington, DC 20003-4595

  • E-mail Form: Click Here

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