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TAX INFORMATION IMPORTANT HEALTH COVERAGE TAX DOCUMENTS Responsible individuals may receive a copy of their Form 1095-B (Health Coverage) by calling our Fund Office at 800.251.4107or 855.450.1875, by emailing a request to hra@uswbenefitfunds.com, or by ma
TAX INFORMATION
IMPORTANT HEALTH COVERAGE TAX DOCUMENTS
Responsible individuals may receive a copy of their Form 1095-B (Health Coverage) by calling our Fund Office at 800.251.4107or 855.450.1875, by emailing a request to hra@uswbenefitfunds.com, or by mailing a request to USW HRA Fund, 1101 Kermit Drive, Suite 800 Nashville, TN 37217. Once your request is received, a copy of your Form 1095-B will be furnished within 30 days.
Forms
| Form Name | Description | Form Category | Download |
|---|---|---|---|
| 401(k) QDRO Form Model | 401K | ||
| Application for Beneficiaries | Contact the Fund Office at 1-800-474-8673 to request an application. | Pension Plan | |
| Application for Pension | Contact the Fund Office at 1-800-474-8673 to request an application. | Pension Plan | |
| Application for Spouse of Pre-Retirement Employee | Contact the Fund Office at 1-800-474-8673 to request an application. | Pension Plan | |
| Claim Form | HRA |
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| Claim Form - Recurring and Third Party | To file for recurring claims payable to a third party | HRA |
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| Continued Coverage for Disabled Child | HRA |
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| Dependent Change Form | Form to add dependents | HRA |
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| Empower Acquisition Disclosure | 401K |
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| Form W-9 | IRS form W-9 to provide correct tax payer identification number (i.e. Social Security Number) | Pension Plan | |
| Form W4P | IRS form to elect or change tax withholding | Pension Plan |
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| HRA - Attestation Form 2024 | HRA |
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| HRA - Opt Out Form | HRA |
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| HRA Enrollment Form | HRA |
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| HRA Forms | Please find HRA Forms on the HRA Account Login Page. To get there, hover over the LOGIN menu option and select HRA Account Login. | HRA | |
| Information Release Form | Authorization for information release (used for pension application). | Pension Plan |
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| Insurance Premium Reimbursement Claim Form | HRA |
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| Legal Name Change Form | HRA |
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| PHI Release Form | Authorization to release personal health information | HRA |
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| Waiver of QPSA | Form for participant's spouse to waive rights to the preretirement survivor annuity | 401K |
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| Withdrawal Liability Estimate Request | Information for participating employers about requesting a withdrawal liability estimate. | Pension Plan |
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Welcome to the Fund Office!
USW Benefit Funds comprises three Taft-Hartley Trusts:
- The PACE Industry Union-Management Pension Fund (PIUMPF)
- The USW Industry 401(k) Fund
- The USW HRA Fund
Each Fund is governed by a Board of Trustees with both labor and management. All must be negotiated and must be included in the collective bargaining agreement.