Non-Unit Dental Insurance Plan Enrollment Form

The Trustees of the Non-Unit Employee Health and Welfare Fund are offering its members an enhanced Indemnity dental plan. In order to participate in this plan an employee has to make a payroll contribution based on the coverage selected. By completing, signing and submitting this form, the employee authorizes the appropriate payroll deduction.

Non-Unit Dental Plan Enrollment Form for Coverage Effective January 1, 2015