Enrollment Application - Health and Security — To properly enroll in the Carpenters Health and Security Plan, you must complete this
form in its entirety and return it to Carpenters Trusts. We cannot process your health care claims and
vacation contributions without your completed form on file at the Carpenters Trusts. Please mail this form to: Northwest Carpenters Trusts. The mailing address, website and telephone number are on the reverse side of this form.
Solicitud de inscripción — Salud y seguridad: para inscribirse correctamente en el plan de salud y seguridad de Carpenters, debe completar este formulario en su totalidad y enviarlo a Carpenters Trusts. No podemos procesar sus reclamaciones de atención médica y contribuciones de vacaciones sin que haya completado su formulario en Carpenters Trusts. Envíe este formulario por correo a: Northwest Carpenters Trusts. La dirección de correo, el sitio web y el número de teléfono se encuentran en el reverso de este formulario.
Dependent Enrollment Application — To enroll a new dependent in the Carpenters Health and Security Plan, you must complete this form in its entirety and return it to Northwest Carpenters Trusts. The mailing address, website and telephone number are on the reverse side of this form.
2023 Open Enrollment Form — Once each year, Oregon participants are allowed to change medical coverage from the Northwest Carpenters Health and Security Plan to the Kaiser Permanente Plan, or vice versa. To change your medical coverage, complete this form and return it to Northwest Carpenters Trusts no later than December 16, 2022.
Authorization To Release/Use Protected Health Information (PHI) — Complete this form to authorize the access, sharing and use of your PHI by individuals and/or organizations.
Change of Address — Please fill out this form and submit it to Carpenters Trusts if your address has changed. (Tip: For a paperless method, log in to the Member Portal and click My Profile.)
Authorization To Transfer Fringe Benefit Contributions - Home Trust — If you are a participant in Northwest Carpenters Trusts but working outside our service area (Washington, Oregon, Idaho, Montana, and Wyoming) use this form to transfer contributions back to Northwest Carpenters Trusts, where your benefits are administered.
Authorization To Transfer Fringe Benefit Contributions - Cooperating Trust — If you are a participant in another trust fund but will be working in Western or Central Washington and want your fringe benefits sent to your home trust, please complete this form.
Change of Beneficiary — Use this form to designate a different person to receive your Life Insurance benefit and/or Carpenters Retirement Plan benefit, if applicable.