Contractor Forms

Click on the form name to download.

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Form Name	Form Purpose
Employer Reporting Form	Blank Monthly Contribution Reporting Form
Remittance Report Example	Remittance Report Example
Reporting Form Instructions-Parent Body	Step by step instructions for completion of Monthly Contribution Reporting Form for Parent Body contractors
Reporting Form Instructions – C-Branch	Step by step instructions for completion of Monthly Contribution Reporting Form for C-Branch contractors
2016 Surcharge Schedule	Surcharge rates effective May 1, 2016
2015 Surcharge Schedule	Surcharge rates effective May 1, 2015
2014 Surcharge Schedule	Surcharge rates effective May 1, 2014
2013 Surcharge Schedule	Surcharge rates effective May 1, 2013
2012 Surcharge Schedule	Surcharge rates effective May 1, 2012
Local 542 County Codes and Districts	Counties, Contract Codes and Districts in Local 542 Jurisdiction

Important Forms

Any retiree, or dependent of a retiree, who is eligible for our insurance must sign up for Medicare parts A and B when eligible.

SUB claims are only eligible within 90 days of the week-ending date.

Maternity Benefits are only for female members and members' spouses. Non-spousal dependent's maternity benefits are not covered.