Plan Documents

Please contact the fund office for plan documents.

Forms

Health & Welfare

Medical Enrollment Package
(English)

Medical Enrollment Package (Spanish)

Life Insurance Enrollment
(English)

Life Insurance Enrollment
(Spanish)

Dependent Removal
Form

Optical Benefits Fee
Schedule

401K

Enrollment Package
(English)

Enrollment Package
(Spanish)

Loan Application
(English)

Loan Application
(Spanish)

Hardship Withdrawal
Application (English)

Hardship Withdrawal
Application (Spanish)

Distribution Application
(English)

Distribution Application
(Spanish)

Age 59.5 Distribution
Application (English)

Age 59.5 Distribution
Application (Spanish)

Partial Distribution
Application (English)

Partial Distribution
Application (Spanish)

401(K) Employee Deferrals
Election Form (English)

401(K) Employee Deferrals
Election Form (Spanish)

Elective Deferrals Distribution
Application

Benefit Funds

Health & Welfare

Find a Medical Provider

Find a Vision Screening

Find a Vision Provider

Find a Dental Provider

Surprise Billing Rights Notice

Transparency in Coverage

The Fund is required to post certain information on a public website pursuant to the Federal Transparency in Coverage Final Rule published in the Federal Register on November 12, 2020.

The Transparency Rule is intended to make information about the prices charged for health care available to the general public, particularly researchers. These experts can use pricing information from the Fund and other health plans to better understand the health care system and its costs and, hopefully, create new policies that improve competition and lower health care spending.

The Transparency Rule requires that the Fund post links to machine-readable files that contain information about the price of health care services. A machine-readable file is written in computer code and is an extremely large file. It is not intended to be downloaded or read by participants but to be used in research studies. The files do not contain Protected Health Information about you or your family. Below is a link to the required machine-readable files.

Links on this website provide machine-readable files for the Fund’s in-network negotiated rate and historical allowed amounts for out-of-network charges. The files attached to the links are maintained by the Fund’s third-party administrator Empire. Empire will update the file attached to the links automatically each month.

Here is the link to the machine-readable files: https://clm.magnacare.com/transparency

If you have any questions about the Transparency Rule, you can read more information at https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f.

Contact List

Medical
MagnaCare: 1-800-226-5116

Pharmaceutical
EmpiRx: 1-877-241-7123

Dental
DDS, Inc: 1-800-255-5681

Vision
Vision Screening: 1-800-652-0063
CPS Optical: 212-675-5745

Member Assistance Program
914-417-5355

401K

Access Your 401K Account

Trustees & Professionals

Trustees

Union Trustees

Joe Azzopardi
John Drew
Albert Blair

Management Trustees

Lina Gottesman

Professionals

Fund Administrator: Joseph Ramaglia
Fund Counsel: Barnes, Iaccarino & Shepherd & Pitta & Giblin LLP
Fund Accountant: Marshall & Moss, LLP
Fund Auditor: Novak Francella, LLC
Fund Consultant & Actuary: Segal Company

Contact

Local 8A-28A Funds
36-18 33rd Street
Long Island City, NY 11101
Phone: 718-361-1770