Authorization for Release of PHI Form:
If you wish to share your Protected Health Information (PHI) with your spouse, parents, employer, etc., you will need to complete an Authorization for Release of PHI Form.

Beneficiary Designation Form:
When you need to designate a beneficiary or need to change your current beneficiaries, a Beneficiary Designation Form should be completed and sent to the Fund Office.

Change of Name Form:
If you need to update your name, a Change of Name Form should be completed and mailed, faxed or emailed to the Fund Office to ensure the most current information is on file.

Change of Address Form:
If you need to update your address, a Change of Address Form should be completed and mailed, faxed or emailed to the Fund Office to ensure the most current information is on file.

COBRA Election Form:
Within 60 days of losing active coverage you can continue coverage under COBRA by filling out the COBRA Election Form and mailing it to the Fund Office. Your first payment is required no later than 45 days after you have elected COBRA coverage.

Initial Disability Form:
If you are a full-time employee and become disabled and unable to work, you and your physician must complete an Initial Disability Form and submit it to the Fund Office in order to receive weekly disability benefits.

Disability Supplement Form:
If your disability period extends beyond the date your physician estimated you would be able to return to work (listed on your Initial Disability Form/previous Disability Supplement Form), then you and your physician must complete a Disability Supplement Form and submit it to the Fund Office to continue to receive weekly disability benefits.

Employer's Statement for Disability Form:
If you are a full-time employee filing for weekly disability benefits, have your employer complete an Employer's Statement for Disability Form and submit it to the Fund Office so your weekly disability benefit can be calculated.

Initial Report of Claim Form:
If your provider does not automatically submit your bill to the Fund office, please complete an Initial Report of Claims Form and return it to the Fund office with the appropriate itemized bills.

Family Update Form - Full Time:
If you have a life-changing event and need to update dependent information, a Family Update Form must be completed and sent to the Fund Office with the appropriate documentation (birth certificate, marriage certificate, divorce decree, etc.).

Update Form - Part Time:
In lieu of a claim form, it is necessary for each part-time participant to fill out the Update Form - Part Time so the Fund office has up-to-date records.

Replacement Accident Letter:
If the Fund Office receives a claim that appears to be the result of an accident or an injury, a letter requesting additional information will be sent to your address. Wilson-McShane is unable to process the claim until the requested information is received. Complete a Replacement Accident Letter if you misplaced or did not receive the original accident letter and the requested information is still outstanding.

Subrogation Form:
Complete a Subrogation Form to acknowledge the Fund’s subrogation and reimbursement interests. For more information regarding subrogation and reimbursement, please contact the Fund Office.

Coverage Opt Out Form:
To opt-out of Plan coverage, to the extent permitted by the applicable collective bargaining agreement, complete a Coverage Opt-Out Form.

Direct Deposit Form:
If you would like to have your checks deposited directly into your bank account, please complete the Electronic Deposit Authorization Form and mail it to the Fund Office.

W-4P Form:
Use Form W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s).

Minnesota Withholding Form:
To elect to have taxes withheld from your pension checks, use the Minnesota Withholding Form.

Pension Application Form:
To apply for a pension, please complete an Application for Retirement Benefits Form and mail pages 1-4, along with proof of age to the Fund Office.

VAPP Election Form:
To elect for VAPP, please complete a VAPP Election Form and mail to the Fund Office.

VAPP Direct Deposit Form:
To elect for VAPP Direct Deposit, please complete a VAPP Direct Deposit Form and mail to the Fund Office.