Listed below are links to useful forms if you have Central States Southeast and Southwest Areas Health & Welfare and Pension Funds benefits through your employer.

For additional forms, pension information or to search for a physician in your area, please visit the Central States site directly at https://centralstatesfunds.org.

Health & Welfare Forms

Member Enrollment Form

Adult Child Enrollment Form

Application for Extension of Coverage

Designation of Beneficiary Form

Health & Welfare General Appeals Procedure 

Health & Welfare Level II Appeals Procedure

Central States Notice of Claim - Death & Accidental Death

Loss of Time Claim Form—Initial Report of Disability

Loss of Time Claim Form - Report of Continued Disability

Teamcare Notice of Claim

Pension Forms

Application for Retirement Pension Benefits

Pension Benefit Appeal Form—Step 1

Pension Benefit Appeal Form—Step 2

Pension Fund Direct Deposit Enrollment Form

Federal Tax Withholding Letter

Central States Publications

Click here for a list of the current Central States Publications