Summary Plan Description

Download the full Summary Plan Description here (pdf)

Claim Form

Make your claim online by securely filling out a Claim Form here.

How to Obtain Form 1095-B

The Form 1095-B is an annual report that identifies which months you and your dependents were enrolled in “minimum essential coverage”. The Fund has provided you a copy of this Form each year, confirming that the Fund coverage meets the requirement of minimum essential standards of coverage set by the Affordable Care Act.  Recently, the Internal Revenue Service (URS) announced that funds no longer need to mail Form 1095-B.  Accordingly, you will not receive a copy of the Form 1095-B in th email, but the Fund will provide a copy to you if you request it.  A copy of theis form will be provided to you within 30 days of y our reaquest.

Please send your request to:

Northern Illinois and Iowa 
Laborers’ Health and Welfare Trust
2837 – 7th Avenue
Rock Island, IL 61201

Or contact the Fund Office via:

If you have any other questions regarding the Form 1095_B, please direct them to the contact information above.


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