IBEW Logo
IBEW Local Union 9
Home | Health Care Information | Pension Information
 
Health Care Information
  Back
 

Forms

Please Note:  In order to view and print the following forms, you must have the Adobe Acrobat Reader installed on your computer.  If you do not have the Adobe Acrobat Reader Software and wish to download it, you may do so by clicking on the image below.

Get Acrobat Reader

  • Change of Address

  • Affidavit Declaring Marital Status

  • Accidental Injury Questionnaire

  • Cobra Election Form

  • Assignment of Benefits

  • BCBSIL Enrollment Form and Yearly Coordination of Benefits and Dependent Status Statement

  • Statement For Loss Of Time Benefits



  • IBEW Local Union 9 Health Care Benefits Web Site
    6525 Centurion Drive, Lansing, MI 48917-9275
    Phone (877)IBEW-155 • Fax 517.321.7508


      Back