DENTAL REIMBURSEMENT
For Active Employees and Dependents Only

Effective January 1st, 2008 the administration of the dental benefits of the Pipe Health and Welfare Fund of Colorado is being handled by Fringe Benefits Services, Inc., instead of Cigna

Fill out and submit the Dental Claim Form with your itemized statements for dental services and proof of payment and send to:

Colorado Pipe Dental Benefits
C/O Fringe Benefits Services, Inc.
P.O. Box 21240
Denver, CO 80221

Or fax to (303) 429-1359
Attn: Dental Reimbursements

Effective January 1st, 2011 Each member covered under CIGNA is eligible for reimbursement up to 90% for: One (1) office visit,
one (1) x-ray, and one (1) cleaning each year.

Colorado Pipe can only reimburse members, they will not directly pay the dental offices.

Submission of the bill does not constitute eligibility. If you would like to verify your eligibility, please call (303) 745-1596.

INSURANCE ENROLLMENT FORM
Please fill out the Enrollment Form and submit the forms to the office on the form. Please include a copy of a marriage certificate if adding a new spouse; and a copy of the birth certificate when adding a new dependant. Please be aware stepchildren are not eligible for coverage unless they are legally adopted by the member, and common law marriage will require additional legal and tax papers.

Effective July 1st, 2011 If you acquire a new dependent on or after July 1st, 2011 (including child or spouse), or if your dependents are not currently enrolled and want coverage for them under the Fund's benefits plans, you must enroll them in the Plan in order for them to be eligible for benefits. If it's a new child, you must enroll him or her within 60 days of birth, adoption, or placement for adoption, whichever applies. If you marry, you must enroll your new spouse within 60 days of the date of your marriage.

Once you enroll your new dependent, their coverage will be effective as of the date they became your dependent (i.e. the date of birth, adoption, or placement for adoption; or the date you married). If you don't enroll them in the Plan within the 60-day timeframe, they will not be covered under the Plan until the first day of the first month after you actually request enrollment. Submitting a claim to the Plan for maternity care/delivery is not considered proper enrollment of the dependent. Coverage will not be retroactive to the date of the event.

Already enrolled dependents are not affected by this new Plan requirement.

If you have any questions on coverage, please contact:
Lori at (303)745-1596.

APPRENTICE WORK REPORT
It is the responsibility of each Apprentice to ensure their Work Report is delivered to the JATC office each month.

JURY DUTY
Please fill out the Request for Jury Duty Pay form completely and mail it along with your Summons for Jury Duty and Jury Service Certificate to:

Plumbers Local No.3
17100 E. 32nd Place
Aurora, CO 80011

Applications will be viewed and approved by the Executive Board which meets every 4th Wednesday of the month. If approved, the checks will be issued after the meeting. Please note your employer is liable for $50.00 a day for the first 3 days of jury duty service. Thereafter, the court will pay $50.00/day for your service.

LANSVILLE SCHOLARSHIP
Only active Plumbers Local No.3 members' children who are entering college or a union trade are eligible for the scholarship. Applicants can only apply for the Frank Lansville scholarship one (1) time. Please submit the completed application with verification of payment for your tuition. Applications are viewed and approved by the Executive Board which meets every 4th Wednesday of the month. If approved, the checks will be issued after the meeting. Proof of tuition payment must accompany your application in order to be approved.

BENEFICIARY FORM
Please make sure the percentages on your Plumbers Local No.3 Beneficiary Form equal 100% if you have designated more than one beneficiary. If you wish the second beneficiary to become the primary beneficiary in the event of the primary beneficiary’s death, please indicate that on the form. You may use two forms if you need more room.

NATIONAL PENSION
If you need to fill out a new beneficiary form for your pension, please contact the hall at (303)739-9300 to request the form be mailed to you. Or if you have any questions about your account and need to contact National Pension directly, call 1-800-638-7442.