Forms and Notices
Please complete and return forms to the Fund Office.
IBEW Local No. 701 Benefit Fund Office28600 Bella Vista Parkway Suite 1110
Warrenville, IL 60555
Tel: (630) 393-1701
Fax: (630) 393-3615
Forms
Change of Address or Name Form (2016) - Update/Change your current address and/or name.
Beneficiary Designation and Dependent Form (2024) - Designate your beneficiaries and dependents.
Spouse Employment Form (2027) - Update your spouse's employment information. This form is required regardless of your marital status or your spouse's employment status.
Spouse Employment Form (2026) - Update your spouse's employment information. This form is required regardless of your marital status or your spouse's employment status.
Loss of Time Claim Form (2016) - Claim for loss of time benefits, you must notify the fund the date you return to work.
Notices
Summary Annual Report (2022) - Summary of the annual report (06/01/2020 through 05/31/2021).
Welfare Fund SMM Dental Max and Wigs (2018) - Increased benefits: Wig, Dental, and Orthodontia.
Welfare Fund SMM Short Hours Self Pay (2018) - The Plan allows you to make self-payments if you fall short of the continuing eligibility requirement of 300 credited hours in a contribution quarter, or 1,200 credited hours during the previous twelve-month period.
Welfare Fund SMM Preventative Services (2019) - The Plan covers a wide range of preventive services designed to keep participants and dependents healthy.
Welfare Fund SMM Progress Lenses (2019) - Effective January 1, 2020, progressive eyeglass lenses will now be paid in full (plastic lenses) when you use a provider that participates in the National Vision Administrators (NVA) plan.
Enhancements to the Specialty Drug Program (2022) - Improvements to benefits: Enhancements to the Specialty Drug Program and foot orthotics covered for Medicare eligible retirees and their dependents.
Weight Loss Drugs (2025) - Coverage for weight loss medications will be covered by the Plan for members and spouses on a permanent basis effective January 1, 2025.
Welfare Fund SMM Temporary Telehealth Benefit (2025) - The Trustees of the IBEW Local 701 Welfare Fund have, effective January 1, 2025, made permanent the former temporary coverage for telehealth visits.
Womens Health and Cancer Rights Act Enrollment Notice (2022) - If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA).
Annual Medicare Part D Notice (2021) - This notice has information about your current prescription drug coverage with the IBEW Local 701 Welfare Fund and about your options under Medicare’s prescription drug coverage.