Toledo Electrical Welfare Fund Supplemental Fringe Benefit 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and Social Security Number (SSN) or Member ID in the designated fields. Ensure accuracy as this information is crucial for processing your claim.
3. Itemize all receipts for health expenses incurred by you or your eligible dependents. Each receipt must be listed individually; do not total them on one line.
4. For expenses covered under other medical insurance plans, attach a copy of the Explanation of Benefits (EOB) received from that carrier along with your request.
5. If applicable, check the box requesting a one-time disbursement of any pended claim amount available up to your contribution balance.
6. Sign and date the form to certify that you will not claim these expenses as a tax deduction and that they comply with plan requirements.
7. Submit the completed form via fax, email, or mail to the Toledo Electrical Welfare Fund using the contact information provided.

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