California southern pipe administrative corporation 2025

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4.8 out of 5

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The document is a claim form for the Southern California Pipe Trades Health & Welfare Fund, intended for active participants and eligible dependents. It outlines the requirements for submitting a claim, including the need for a new form each calendar year or for each new injury. The form collects participant and patient information, details about other coverage, and specifics regarding the injury or illness being claimed. It also includes an authorization section for the participant to certify the accuracy of the information provided.

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Click ‘Get Form’ to open it in our platform's editor.
Begin with Part I: Participant & Spouse Information. Fill in the participant's name, Social Security Number (last four digits), date of birth, and address. Ensure all fields are completed accurately.
Next, provide the spouse's information if applicable. Include their name and any relevant details as required.
Move to Part II: Patient Information. Enter the patient's name, address (if different), phone number, marital status, relationship to the participant, and gender.
In Part III: Other Coverage or Benefits, indicate if the patient has other insurance coverage. If yes, provide details about the policy holder and type of coverage.
Proceed to Part IV: Claim Information. Specify whether this claim is for a new injury or illness and describe the incident thoroughly, including when and where it occurred.
Finally, complete Part V: Authorization by signing and dating where indicated. Ensure that all necessary signatures are provided to avoid delays in processing your claim.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (88 Votes)
2008	4.3 Satisfied (262 Votes)

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What does scptac stand for?

The Southern California Pipe Trades Administrative Corporation (SCPTAC) Fund Office administers benefits for your Employees under the terms of a collective bargaining agreement between Employers and District Council No.

How is scptac funded?

The Southern California Pipe Trades Retirement Fund is a defined benefit pension plan where employers contribute to the Fund on behalf of their covered workers under a collective bargaining or participation agreement.

What is the Southern California drug benefit fund?

The Southern California Drug Benefit Fund is a multiemployer welfare benefit plan providing hospital-medical, chemical dependency treatment, dental, orthodontic, psychiatric, prescription, predictive medicine, death, supplemental unemployment and disability benefits to eligible participants and their dependents.

scptac forms

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How is TChatt funded?

TCHATT services are funded through the state by Senate Bill 11 and are completely free to students, families, and schools. HOW DO PARENTS AND EDUCATORS ACCESS TCHATT SERVICES? TCHATT services can be accessed by contacting your school counselor and requesting they make a referral.