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
2022-Aetna Enrollment form (pdf)
Download2022-Aetna Enrollment form-DEPENDENT (pdf)
DownloadIndividual Account Claim (IAP) Form (pdf)
DownloadAETNA RX Home Delivery Medication Order Form (pdf)
DownloadIAP Claim Workbook (Helps you to calculate & organize your receipts (xlsx)
DownloadSupplemental Disability Allocation Form (pdf)
DownloadAppeals of Adverse Determination (pdf)
Download