ATTENTION H&W PARTICIPATING MEMBERS: NEW PHARMACY BENEFIT MANAGER

Local 399 H&W participating members, please click on the link below to view information on our Pharmacy Benefit Manager change that is effective on January 1, 2025.

Click here for details

H&W Provider Links

H&W Forms Resource

Thank you for visiting the Forms Resource Page.
Please click on the images below
to view/download forms.

Enrollment Form

Address Change Form

Dependent Change Form

Coordination of Benefits Form

Short Term Disability Form

VSP Reimbursement Form

BCBSIL Claim Form

Delta Dental Claim Form

OptumRx Claim Form

Accident Form

CVS/Caremark Claim Form

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IUOE Local 399 Union Hall and Training Facility • 2260 S. Grove St. Chicago, IL 60616 • Tel: 312-372-9870 • Fax: 312-842-1590