Building a Better Benefits Plan

Please note that some of these forms require you to provide protected information such as your Social Security Number or date of birth.  

For your security, it is strongly suggested that you return these forms to the Funds Office via secure fax at 508-533-1404, 

or via mail at IUOE Local 4 Benefit Funds Office, P.O. Box 660, Medway, MA 02053-0680.


Loss of Time Forms

Loss of time Form

Request for Federal Income Tax Withholding From Sick Pay W-4S


Subrogation Form


Authorization for Release of Protected Health Information


Claim Forms

Bridge Plan Enrollment Form

Caremark Prescription Drug Claim Form

Caremark Mail Service Order Form

Davis Vision Direct Reimbursement Claim Form

Medical Subscriber Claim Form


Administrative Forms

Authorization to disclose to Attorneys and others

Census card / Enrollment

Change of Address

Wellness Forms

Fitness Reimbursement

Weight-Loss Reimbursement