Updated 2/16/2026: The Midwest Operating Engineers Welfare Fund Privacy Notice has been updated to comply with federal requirements, including additional protections for psychotherapy notes and Substance Use Disorder (SUD) records governed by 42 CFR Part 2 (Code of Federal Regulations). Tap the button above to view the full notice.
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To view additional plan documents, you can visit your My150 and click on My LIBRARY
Forms
- Accidental Dismemberment Benefit Claim Form
- Active Employee Death Benefit Beneficiary Designation Form
- Appeal Request Form
- Adult Child Enrollment Form
- Change of Address Form
- Phone: Call Member Services to verify your identity and update your address quickly over the phone.
- Online:Log into My150 and update your information under the “MyProfile” tab.
- By Mail or In Person: Complete this form, have it notarized, and either mail it to the Fund Office or drop it off at any Local 150 District Office.
- Disability Claim Instructions and Forms
- Disabled Dependent Eligibility Review Form
- Electronic Consent Form
- Family Supplemental Benefit (FSB) Claim Form
- HIPAA/Privacy Forms
- Health & Welfare Inquiry Form
- Medical Claim Form- Manually submit a claim form to BCBS when your provider did not bill BCBS directly. Mail the form, itemized bill, and paid receipts (when applicable) to the specified address on the form. To ensure correct filing, the provider’s Tax ID number must be included on the form.
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- Services Received Within the Blue Cross Blue Shield of Illinois Region- Domestic Claim Form
- Services Received Outside of the United States – International Claim Form
- This form is for services received outside of the United States and should be returned to the address listed on the form
- Services received outside of the Blue Cross Blue Shield of Illinois Region
- Please download the appropriate domestic or international from your state’s local BCBS website and return it to the address listed on the form
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- Reciprocity Transfer Form
- Retiree Medical Savings Plan (RMSP) Claim Form
- Retiree Medical Savings Savings Plan (RMSP) Beneficiary Form
- Please submit this information to the Member Services Department at the Fringe Benefit Funds Office
- VOYA Beneficiary Designation Form
- This form is used to update the MCL $10,000 basic death benefit (for members only) and for the Supplemental Life Insurance. Once the form is completed, please mail to: Kocher Insurance Group, Inc.
ATTN: Will McCabe
1165 N. Clark Street, 7th Floor
Chicago, IL 60610
- This form is used to update the MCL $10,000 basic death benefit (for members only) and for the Supplemental Life Insurance. Once the form is completed, please mail to: Kocher Insurance Group, Inc.
Notices
- Summary of Material Modifications (SMM)- Welfare Fund Gene Therapy Exclusion
- Summary of Material Modifications (SMM)- COVID-19 Updates
- Effective April 1, 2022- Welfare Fund No Surprises Act (NSA) Transparency Notice
- Welfare Fund Annual Breast Reconstruction Notice & Notice of Creditable Coverage – October 2025
- Welfare Fund Summary Annual Report for the Plan Year ending March 31, 2025