Michigan Laborers'Fringe Benefits Home Page Health Care Section

 

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Forms
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  • Affidavit Declaring Marital Status

  • Application for Member Death Benefit

  • Assignment of Benefits Form

  • Application for Dependent Spouse Death Benefit

  • Pension Deduction Authorization Form

  • Retiree Information Form

  • Retiree Election Form

  • Coverage Election Form

  • Student Verification Form

  • Yearly Coordination of Benefit and Dependent Status Statement

  • Change of Address Form

  • Direct Debit Authorization Agreement

  • Blue Cross Enrollment Form

  • Statement for Loss of Time Benefits

  • Pension Deduction Form

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