COBANC Health & Welfare Fund - Retirees
Retiree Supplemental Benefits Plan
Enrolling For Benefits and Updating Your Information
To enroll for benefits please complete a Health & Welfare Enrollment/Information Form (see link below). Be sure to fill out a new form each time you need to update your information, such as adding a dependent or changing your address, phone, or email. Enrollment of a dependent requires your form to be accompanied by a copy of the marriage certificate, domestic partner application (see link below), birth certificate, adoption papers, etc. Please remember to sign and date your form.
Click or tap a link below to view or download
Enrollment/Update Form (It is preferable that you fill out this form electronically, then print, sign and date it before submitting it. If you hand-write, please print legibly.)
Domestic Partner Application
Termination of Domestic Partnership Application