Healthcare Plan Information Sheet (New Members)

If you have been requested to submit the Healthcare Plan Information Sheet,
first print/download the directions and form and then you may use any of the methods below to submit the form.

Be sure to include your signature/spouse signature
(No information will be accepted without a signed form)


PRINT/DOWNLOAD

FAX
1.) Complete the form, including signature.
2.) Then, FAX it to 763-416-6196

EMail
1.) Complete the form, including signature
2.) Scan the form
3.) Create a new email using this link: hcforms
         or
      Use your email and send to
hcforms@ibew292benefits.org
4.) Insert/attach the scanned form into the email.
5.) Send the email

US Post Office
1.) Complete the form, including signature.
2.) Then, return to address on the form


 


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