Milwaukee Drivers Health and Welfare Trust Fund

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Documents and Forms

  • Home
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  • 5
  • Documents and Forms

General

Contact List

Plan A Enrollment Form

Plan B Enrollment Form

Change Form

COBRA Election Form

Family Information Form

Employees Statement of Claim Form

Attending Physician Statement

Active Members

Schedule of Benefits Plan A (Actives)

Schedule of Benefits Plan B (Actives)

Summary of Benefits Coverage Plan A (Actives)

Summary of Benefits Coverage Plan B (Actives)

Retirees

Summary of Benefits Coverage Plan B (Non-Medicare Eligible Retirees)

Required Notices

COBRA Continuation Notice

Claims and Appeal Notice (2018)

Privacy Notice (2018)

Summary of Material Modifications (2022)

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) Notice (2024)

Notice of Creditable Coverage (2024)

Women’s Health and Cancer Rights Act Notice (2024)

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New to the Fund?

To gain access to your benefits, you must first enroll in coverage for you and your dependents.

Learn More

Contacts

The Health Fund Office

Milwaukee Drivers Health & Welfare Trust Fund

10020 West Greenfield Avenue
Milwaukee, WI 53214
414-258-2336 or 800-255-3340
Fax: 414-258-9419 (Office and fax hours: Monday – Friday 8:00 a.m. to 4:30 p.m.)

Related Pages

Contacts
Terms to Know
Enrollment
  • How to Enroll
  • Eligibility
  • Life Events
  • COBRA
Active Members
  • Medical
  • Prescription Drug
  • Dental
  • Vision
  • Disability
Retirees
  • About Your Coverage
  • Medical
  • Prescription Drug
  • Dental
  • Vision
Employers
Resources
  • Contacts
  • Documents and Forms
  • Terms to Know
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