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-

  • New enrollment forms.
  • Signed & dated copy of a divorce decree or
  • Letter of credible coverage or
  • Copy of death certificate.


If you have any questions on how to fill out the forms, please call 319-366-0859.

Please mail all forms to the addresses listed on the forms. 

Physical Form

IALABR VisionClaimForm


Enrollment Form IALABR

The Laborers’ Code of Performance

Skill Sheet

Referral Rules Jan 2024

Recip Form

LIUNA Economy Enrollment Form

Ullico Life Insurance

GPLDC Fringe Benefit Form