CONNECTICUT CARPENTERS BENEFIT FUNDS
10 BROADWAY, HAMDEN, CT 06518 | (203) 281-5511 | FAX (203) 288-3235 | (800) 922-6026

Members
Login here for access to your personal fund information

Employers
Login in here for access to the on-line contribution reporting system and receipts

Contribution Forms

NE Regional Council of Carpenters

CT Locals

Local 24

Local 43

Local 210

Several documents including beneficiary designation cards, applications for retirement and withholding forms are available on line. 

Complete Forms On-Line---  Many but not all of the forms below may be completed on-line, printed and then mailed to the Funds.  To complete the forms on-line simply click on the desired form below and then click on the desired section(s) of the form you would like to complete and type in the desired information prior to printing. 

To view these forms Adobe Acrobat Reader must be installed on your computer.  If you do not currently have Adobe Acrobat, you may download a free version of the Adobe Acrobat Viewer by clicking on the link below.

Health

• Health Benefit Claim Form (46Kb)

• Disability Claim Form (104Kb)

• Adult Dependent Election Form

• Authorization to Disclose Protected Health Information (126Kb)

• Appointment of Personal Representative Form (100Kb)

• COBRA COBRA General Notice (121Kb)

• COBRA Notice A (117Kb)

• COBRA Notice of Qualifying Event (82Kb)

• COBRA Notice of early Termination (84Kb)

• Summary Annual Report (18Kb)

Plan Booklets

Health Plan

Pension Plan

Annuity Plan

Pension

• Pension Application (3.36Mb)

• Election for Income Tax Withholding (239Kb)

• Request for Reciprocity of Hours or Contributions (110Kb)

• Doctor's Statement for Disability (104Kb)

• Direct Deposit Authorization (18Kb)

• Qualified Domestic Relations Order (QDRO)

• Pension Appeal Rights (28Kb)
• Form 5500 (161Kb)

Network Information
Provider Directory

Important Anthem Notice

click here for update

Find a Doctor:

Click here to be linked to the Physician Provider Directory

Medical ID Cards:

Please be sure to bring your new Anthem Medical ID Card with you

to all provider visits

Annuity

• Application for Benefits (5.27 Mb)

• Special Tax Notice (40kb)

• Summary of Withholding Options (104 Kb)

• Election for Income Tax Withholding (58 Kb)

• Voluntary Contribution Procedures and Election Form (138 Kb)

• Qualified Domestic Relations Order (QDRO)

• Summary Annual Report (18Kb)

Other

• Explanation of Forms of Payment (208 Kb)

• Authorization for Payment of Health Self-Pay from Fund (88 Kb)

• Request for Reciprocity of Hours or Contributions (110 Kb)

  Please be sure to present your new ID card at all pharmacy visits

Member Assistance Program

1-888-373-5073