Forms – Laborers Local 43

Listed below are some important forms within our office and how to add and remove dependents from insurance.

Documentation needed to add/remove dependents:

To add a spouse-

Copy of Marriage certificate & new Iowa Laborer’s Health & Welfare Plan enrollment form.
Statement of “loss of coverage” & new enrollment forms

To add a new baby/adopted child-

New enrollment forms, copy of social security card, copy of birth certificate.
New enrollment forms & signed, dated copy of the adoption papers & copies of the new birth certificates.

To add a child-

Copy of the child’s birth certificate; if you are not listed on the birth certificate as the child’s father/mother, then we will also need a court order establishing paternity or something from the state showing payment of child support.

To add a step-child-

New enrollment forms.
Copy of the most recent tax statement naming the child as a dependent.
Notarized statement signed by the participant and their spouse stating that the child is a) living with the participant in a regular parent/child relationship; b) that you contribute more that 50% toward the maintenance and support of the said child; c) the child is neither covered nor required to be covered by any other health plan or person.

To term/delete a dependent-