Health & Welfare Forms Now Available Electronically

All of the Health and Welfare Fund’s forms are now available in electronic format (as Adobe PDF’s). They can be filled out on your computer and printed and mailed back, or emailed back using secure email transmission. To find out if you qualify for benefits and to request an electronic form, please call the Fund office at 216-241-2828 or toll free at 800-241-2828, Monday-Friday 8:30 am to 5:00 pm. In order to receive an electronic form, you must provide the Fund office with a valid e-mail address.

Requested forms will be sent out using the Fund’s secure e-mail account. The first time you receive secure email from the Fund, you will be prompted to register your e-mail address and to establish a strong password. To read subsequent e-mails from the Fund office, you will need to login with your username and strong password. To register, simply click on the link in the email from the Fund. This will take you to the secure site for registration, to open your mail, and to download the form.

Once you have downloaded the blank form to your computer, you can open it, print it and fill it out by hand. You can then mail it back to the Fund office via snail mail, or hand-deliver it:

United food and Commercial Workers Union-Employer Health and Welfare Fund
9199 Market Place, Suite 1
Broadview Heights, OH 44147

Alternatively you can save the form to your computer, open the form, fill it in on your computer screen, then save it. You can then print the completed form, sign it, and snail-mail it or deliver it to the Fund office.

Or, you can save the form to your computer, open the form, fill it in on your computer screen, sign the form electronically, and save it. Then simply reply to the email you received from the Fund, attaching the completed form. You must use Reply in order to send it back securely.

The email address for sending and receiving all forms is Please make sure that you can receive email from this address without it going to your e­mail’s “Spam” or “Junk” folder. If you requested a form and don’t see it in your Inbox, check your Spam and Junk folders.

Detailed instructions for completing the electronic form and for affixing an electronic signature will be included in the secure e-mail sent to you.


Dental Forms
Time Loss – Pregnancy
Covid Test Reimbursement
Medical Only
Time Loss
Metro Health
Time Loss – Supplemental

ufcw UFCW Local 880
9199 Market Place, Suite 2, Broadview Heights, OH 44147
216-241-5930 or Toll Free 800-241-5930