QUESTIONNAIRE

If the Health & Welfare Fund is unable to obtain the additional requested information, your claim will be denied. Accordingly, in order for the Health & Welfare Fund to receive the additional requested information as soon as possible, please complete and submit the Questionnaire that can be found at link below. Once you complete and submit the below Questionnaire, the Health & Welfare Fund will receive your response through this website... The Central States Joint Board Health & Welfare Trust Fund ("Health & Welfare Fund") provides welfare benefits to you and your Dependent(s) through collective bargaining. In order to keep health care cost at the lowest rate possible for you and your Dependent(s), in certain circumstances, the Health & Welfare Fund will request additional information regarding the medical services received in order to determine if another plan or party could be responsible for the cost of your medical services.

Primary location: Chicago United States