Once you’re eligible for benefits, you are sent a welcome package that includes enrollment forms to complete and return to the Fund Office within 60 days of your initial eligibility date. Note: If you don’t enroll by the 60-day deadline, your coverage may be delayed.
To enroll yourself and your eligible spouse or domestic partner and dependent children, you must send the Fund Office a properly completed Enrollment & Beneficiary Form along with the documents explained on the form. Processing will be delayed until all required documents are received.
Enrollment Forms:
Inland Enrollment & Beneficiary Form (PDF)
ULLICO Life/AD&D Enrollment Beneficiary Form (PDF)
United HealthCare (HMO) Enrollment Form (PDF)
Delta Dental Enrollment & Change Form (PDF)
VSP Vision Enrollment Form (PDF)
Authorization to Disclose Protected Health Information Form (PDF)
REMINDER: Processing will be delayed until all required documents are properly completed and received by the Fund Office. For enrollment questions, contact the Fund Office at (800) 595-7473 and follow the prompts for the Inland Refrigeration Trust Funds.
