Contact Numbers:

FUNDS' Call Center:
(800) 291-1425

Administration:
(202) 521-2200

Provider Services Claims:
(888) 865-5290

Precertification:
(800) 292-2288

Pharmacy:
(800) 294-4741

© Copyright 2007
UMWA H & R Funds
All Rights Reserved

	Applications
	Pension Application
	Surviving Spouse / Death Benefit Application
	Health Benefit Application
	Certificates of Retirement
	Certificate of Retirement Classified Signatory Service (Union Position)
	Certificate of Retirement Non-Classified / Non-Signatory Service (Non-Union Position)
	Certificate of Layoff (Layoff from Union Position)
	Other Information
	Change of Address Form
	Tax Withholding Form
	Beneficiary Designation Form
	Direct Deposit Enrollment
	Request to Discontinue Direct Deposit
	Request for withdrawal of union dues from Pension check (Mineworker)
	Request for withdrawal of union dues from Pension check (Surviving Spouse)
	Right to Appeal Pamphlet
	Request for Hearing Form
	Guidelines for Awarding Pension Credit re: Back Pay
	Death Benefit Tax Election for an Estate or Organization
	Death Benefits Tax Election for Applicants Who Are NOT an Estate or Organization

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Applying for Benefits

Summary Plan Descriptions

UMWA H & R Funds
2121 K Street N.W.,
Washington, DC 20037