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
Eligible employees may enroll in a National IAM Benefit Trust Fund vision plan by completing and submitting this form. This form is also used to enroll eligible dependents.
- Disabled Dependent Certification Form
Eligible employees wishing to designate an eligible disabled dependent must complete and submit this form in addition to the enrollment form. The Physician Certification of Disability Form must be completed by both the employee and the dependent's attending physician.
- Eligible Dependent Certification Form
Eligible employees who designate eligible dependents who are not the employees' biological children, or who have a different last name from the employee, must certify the dependent's eligibility for coverage by completing and submitting this form in addition to the enrollment form.