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