Boilermakers National Funds

Documents & Forms

Annuity Documents & Forms

ANU - Annuity Beneficiary Form 10.2019

ANU - Determination Letter from IRS 021116

ANU - Notice of Military Service Credit (USERRA)

ANU - Plan Document effective 013015 and Amendments updated 06292021

ANU - Summary Annual Report 2017 (published 2018)

ANU - Summary Annual Report 2018 (published 2019)

ANU - Summary Annual Report 2019 (published 2020)

ANU - Summary Annual Report 2020 (published 2021)

ANU - Summary Plan Description (effective 07012019) and Plan changes thru 12012021

ANU - Trust Agreement and Amendments 07012020

Employers Documents & Forms

EC - 10 - Payroll Auditing FAQ (Revised 202002)

EC - 14 - Contribution Due Date Notice (Published 201402)

EC - 3 - ACH Information for All Funds (Revised 201911)

EC - 4 - Employer Information Request Form (Revised 20181120)

EC - 7 - Alumni Agreement Important Information Notice (Published 201709)

EC - 8 - Employer Alumni Agreement (Revised 20191114)

EC - 9 - Employee Alumni Election Change Form (Revised 20220208)

EC - ANU - Summary Annual Report 2017 (published 2018)

EC - ANU - Summary Annual Report 2018 (published 2019)

EC - ANU - Summary Annual Report 2019 (published 2020)

EC - ANU - Summary Annual Report 2020 (published 2021)

EC - ANU - Summary Plan Description (effective 07012019) and Plan changes thru 07012020

EC - ANU - Trust Agreement and Amendments 07012020

EC - PEN - 13th Pension Plan Restatement effective 020115 and Amendments 06292021

EC - PEN - 2017 FASB Disclosures 201811

EC - PEN - 2018 FASB Disclosures 201911

EC - PEN - 2019 FASB Disclosures 202011

EC - PEN - 2019 Rehabilitation Plan

EC - PEN - 2020 FASB Disclosures 202111

EC - PEN - 2020 Funding Improvement Plan

EC - PEN - 5500 Summary Notice 104(d) 2017 (published November 2018)

EC - PEN - 5500 Summary Notice 104(d) 2018 (published November 2019)

EC - PEN - 5500 Summary Notice 104(d) 2019 (published November 2020)

EC - PEN - 5500 Summary Notice 104(d) 2020 (published November 2021)

EC - PEN - Notice of Annual Funding 2018 (published April 2019)

EC - PEN - Notice of Annual Funding 2019 (published April 2020)

EC - PEN - Notice of Annual Funding 2020 (published April 2021)

EC - PEN - Notice of Annual Funding 2021 (published April 2022)

EC - PEN - Notice of Plan Status 2018 (published 2019)

EC - PEN - Notice of Plan Status 2019 (published 2020)

EC - PEN - Notice of Plan Status 2020 (published 2021)

EC - PEN - Summary Plan Description effective 070116 and Plan changes thru 04012021

EC - PEN - Withdrawal Liability Valuation as of 123119

EC - PEN - Withdrawal Liability Valuation as of 123120

EC - PEN – Trust Agreement effective 1-12-1983 and Amendments 19-40

Health & Welfare Documents & Forms

HW - 2018 Evidence of Coverage and SPD with Amendments 1-7

HW - 2021 National Preferred Formulary Drug List

HW - 2022 United Healthcare Plan Guide

HW - Appointment of Authorized Representative Form

HW - Authorization Form to Release Personal Information

HW - Authorization to Release Protected Health Information

HW - BNF Vision Claim Form (202109)

HW - CIGNA Long-Term Disability Information

HW - COB and Information Verification Form (202110)

HW - COBRA AEI Notice of Other Coverage Form

HW - COBRA Continuation Coverage Election or Rejection Form

HW - COBRA Request for Treatment as AEI Subsidy Form

HW - Children's Health Insurance Program Notice 2020

HW - Dependent Child Enrollment Form

HW - Designation of Beneficiary Card

HW - Disclaimer of Benefits Form

HW - Express Scripts COVID19 TEST Claim Form

HW - Express Scripts Prescription Drug Claim Form

HW - M Coverage Enrollment Form updated 100121

HW - M Coverage Open Enrollment Packet for 2022 Plan Year

HW - Minimum and Affordability Status 2020

HW - No Surprise Billing Disclosure Notice

HW - Notice of Creditable Prescription Drug Coverage 2020

HW - Privacy Practices 2020

HW - Summary Annual Report 2020 (published 2021)

HW - Summary of Benefits and Coverage Active 2021

HW - Summary of Benefits and Coverage Active 2022

HW - Summary of Benefits and Coverage Retiree 2021

HW - Summary of Benefits and Coverage Retiree 2022

HW - Summary of Benefits and Coverage Uniform Glossary 2021

HW - Trust Agreement 03072022

HW - Womens Health and Cancer Rights Act 2020

Pension Documents & Forms

PEN - 13th Pension Plan Restatement effective 020115 and Amendments 06292021

PEN - 19th SRWR Local Labor Shortage List 09162021

PEN - 2018 Pension Funding Improvement Plan

PEN - 2019 Rehabilitation Plan

PEN - 2020 Funding Improvement Plan

PEN - 5500 Summary Notice 104(d) 2016 (published November 2017)

PEN - 5500 Summary Notice 104(d) 2017 (published November 2018)

PEN - 5500 Summary Notice 104(d) 2018 (published November 2019)

PEN - Application Instructions (revised 10.12.2020)

PEN - Application Timeline 2017

PEN - Determination Letter from IRS 110615

PEN - Direct Deposit Letter and Form (1.19.2021)

PEN - Notice of Annual Funding 2017 (published April 2018)

PEN - Notice of Annual Funding 2018 (published April 2019)

PEN - Notice of Annual Funding 2019 (published April 2020)

PEN - Notice of Annual Funding 2020 (published April 2021)

PEN - Notice of Annual Funding 2021 (published April 2022)

PEN - Notice of Plan Status 2017 (published 2018)

PEN - Notice of Plan Status 2018 (published 2019)

PEN - Notice of Plan Status 2019 (published 2020)

PEN - Notice of Plan Status 2020 (published 2021)

PEN - Pension Benefit Factor Chart Effective 10-1-2017 for Non grandfathered Status FINAL

PEN - Pension Benefit Factor Chart Effective 5.1.2019 for Non grandfathered

PEN - Summary Plan Description effective 070116 and Plan changes thru 12012021

PEN - W-4P Tax Form (US only)

PEN – Trust Agreement effective 1-12-1983 and Amendments 19-40

Pen - Pension Benefit Factor Chart Effective 100117 for Grandfathered Status Final

BNF - Authorization Form to Release Personal Information

BNF - Change of Personal Information Form (Aug 2021)

BNF - EBSA Online Security Tips

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BNF Non-Discrimination Statement

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