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December 27, 2016 | Search | Print | Site Map | Help
 

Active Health and Welfare Trust Fund

 
Enrollment Forms
Life Insurance Forms
Other Forms

Health and Welfare Benefit Claim Forms

  • Direct Pay Dental Claim Form (File size - 156 K)
    Complete and return this form to the Automotive Industries Welfare Fund Office when you have a dental claim.
  • Disability Claim Form (File size - 107 K)
    Complete and return this form to the Automotive Industries Welfare Fund Office when you have a disability claim.
  • Medical Claim Form (File size - 110 K)
    Complete and return this form to the Automotive Industries Welfare Fund Office when you have a medical claim.
  • Prescription Solutions Claim Form (File size - 27 K)
    Complete and return this form to Prescription Solutions when you have a prescription claim.
  • Orthodontic Claim Form (File size - 124 K)
    Complete and return this form to the Automotive Industries Welfare Fund Office when you have a orthodontic claim.

Mail Order Pharmacy Forms

Annual Notices

Notices of Creditable Coverage

Summary Annual Reports
  • SAR (File size - 598 K)
    For the Year Ended December 31, 2012.
  • SAR (File size - 132 K)
    For the Year Ended December 31, 2011.
  • SAR (File size - 36 K)
    For the Year Ended December 31, 2010.
  • SAR (File size - 212 K)
    For the Year Ended December 31, 2009.
  • SAR (File size - 163 K)
    For the Year Ended December 31, 2008.
  • SAR (File size - 12 K)
    For the Year Ended December 31, 2007.
  • SAR (File size - 36 K)
    For the Year Ended December 31, 2006.
  • SAR (File size - 73 K)
    For the Year Ended December 31, 2005.
  • SAR (File size - 17 K)
    For the Year Ended December 31, 2004.
  • SAR (File size - 29 K)
    For the Year Ended December 31, 2003.
  • SAR (File size - 24 K)
    For the Year Ended December 31, 2002.
  • SAR (File size - 8 K)
    For the Year Ended December 31, 2001.
  • SAR (File size - 8 K)
    For the Year Ended December 31, 2000.
 
Other Reports
  • Delta Dental Benefit Highlights (File size - 230 K)
    DeltaPreferred Options USA (DPO USA) Benefits Highlights for Automotive Industries Active Welfare Plan.

Contact Plan Administrator
regarding questions about your benefits

Telephone NumberPhone
(800) 635-3105
(510) 836-2484

Contact FormCustomer Support

Click for MapVisit Us
Associated Third Party
Administrators (ATPA)
1640 South Loop Road
Alameda, CA 94502

Contact Website Technical Support
regarding questions related to the use of this website.

Toll Free(866) 367-8265

Toll FreeWebsite Technical Support