To view additional plan documents, you can visit your My150 and click on My LIBRARY
Forms
- Electronic Consent Form
- Retiree Medical Savings Plan (RMSP) Claim Form
- Retiree Medical Savings Plan (RMSP) Beneficiary Form
- Please submit this information to the Member Services Department at the Fringe Benefit Funds Office
Notices
- Retiree Welfare Plan Summary Annual Report (SAR) (For Plan Year January 1, 2023 through December 31, 2023)
- Summary of Material Modifications (SMM)- COVID-19 Updates
- Pre-Medicare Retirees- Annual Breast Reconstruction Notice & Notice of Creditable Coverage as of October 2024
- Medicare Retirees- Annual Breast Reconstruction Notice as of October 2024
- Pre-Medicare Retirees- Summary of Benefits and Coverage (For Plan Year January 1, 2024 through December 31, 2024)