Benefit Forms
Click Relief Benefit Form - Fax completed form to (304) 242-3946
Click HERE for the 4th District Monthly Disability Form - Fax completed forms to (304) 525-6005
Click HERE for the 4th District Monthly Disability Form for Continuance of Coverage
Click HERE for the Designation on Beneficiary Form for the LU 141 Profit-Sharing Plan
Click HERE for the Designation of Beneficiary form for the LU 141 Vacation Plan
Click HERE for the Designation of Beneficiary Form for 4th District Health Fund
Click HERE for the Designation of Beneficiary Form for the Pension Benefit Fund
Click HERE for Address Change Form for the NEBF
Click HERE for Address Change Form for the International Office
Click HERE for how to use the NECA-IBEW HRA Benefits Mobile App
Click HERE for the Benny Card reimbursement form
Click HERE for the VSP benefits sheet
Click HERE for VSP Out-of-Network Form
Click HERE for NEBF status request form
Authorization of Self pays from HRA