Documentation

Plumbers’ Welfare Fund, Local 130, U.A.

Required Participant Information

Any of the following events requires Participants and/or dependents to send the proper associated documentation to the Welfare Fund office:

Event	Required Documents
Marriage	(1) Copy of Marriage certificate (2) New Beneficiary Card (3) Coordination of Benefits form
Divorce or Legal Separation	(1) Copy of Divorce decree or Court Order (2) New Beneficiary Card
Birth	(1) Copy of Child’s birth Certificate (2) Copy of Social Security Card (3) New Beneficiary Card
Termination of Spouse’s primary insurance	Letter of Termination from Primary insurance
New employment of spouse	Coordination of Benefits form
Dependent child reaching the age of 19	Copy of full-time student verification letter from an accredited college
Change of address	E-mail to kpoon@plumberslu130ua.com

Important Notice: This website provides only a brief explanation of the Health and Welfare Plan under the Plumbers’ Welfare Fund, Local 130, U.A. and is not a summary plan description. If there are any inconsistencies between this explanation and the Plan document, the Plan document shall control. Also, please refer to the Summary Plan Description for additional information about the benefits available and procedures of the Plumbers’ Welfare Fund, Local 130, U.A. or contact the Plumbers Welfare Fund Office .