Health & Welfare and Pension Funds
of Philadelphia and Vicinity

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Click on the particular form you need.  You must have Adobe Acrobat Reader to access these documents.  To download a free copy of Adobe Acrobat Reader, click here.

 Weekly Disability Claim Form Weekly Disability Continuation Form
Dental Claim Form Direct Pay Prescription Drug Form
Vision Claim Form Student Verification Form 
HIPAA Authorization Census / Beneficiary Designation Form
Mail Order Form for Prescriptions   Horizon Medical Claim Form
COB Declaration of Health Coverage   Adult Dependent Coverage Certification

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 Last Date Updated :  08/09/11