FUND OFFICE RELATED FORMS AND DOCUMENTS

You can easily download any of the forms you need and print them at home to be completed and returned to the Fund Office.

For any documents that you do not see listed here or for any other Fund Office related information, please email us at 195funds@rooferslocal195.com
or call us at (315) 699-1388 M-F 8:30am to 4:30pm

AETNA - Transparency in Coverage Final Rule

The Transparency in Coverage final rule, released on October 29, 2020, requires health plans and issuers to publicly disclose pricing information via machine-readable files (MRF).

As a self-funded plan sponsor, we are responsible for complying with the regulations and Aetna is committed to working with you to meet the MRF requirements of the Transparency in Coverage final rule.

Transparency in Coverage

Health Related Enrollment and Claim forms

07-01-2022-Aetna Enrollment form (pdf)

Roofers Local # 195

FUND OFFICE RELATED FORMS AND DOCUMENTS

AETNA - Transparency in Coverage Final Rule

Health Related Enrollment and Claim forms

PRIMARY, SECONDARY & SPOUSAL INSURANCE INFORMATION FORMS

rELEASE OF INFORMATION FORMS

MISCELLANEOUS FORMS

pARTICIPANT'S dESIGNATION OF bENEFICIARY fORMS