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
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.
2023-Aetna Enrollment Form (pdf)
Download2022-Aetna Enrollment form (pdf)
DownloadAetna 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)
DownloadAppeals of Adverse Determination (pdf)
Download