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Beneficiary Designation
This form is used to elect or change your beneficiary information.
Click on the link, for the Fund you would like to update, to open a printable form.
Open H&W, Pension-A, Pension-B

Direct Deposit Authorization (Plan-A)
To update your bank deposit information for Pension Plan A, please click here for a printable form.
Open Direct Deposit Authorization (Plan-A)

Tax Withholding Form (Plan-A)
To update your tax withholding for Pension Plan A, please click here for a printable form.
Open Tax Witholding Form (Plan-A)

Investment Direction Form (Plan-B)
To change your investment elections for Pension Plan B, please click here for a printable form.
Open Investment Direction Form (Plan-B)

Enrollment Form
To add a dependent, please click here for a printable form.
Open Enrollment Form

HRA Claim Form
To print out an HRA Claim Form, click the following link.
Open HRA Claim Form

Adult Child Enrollment Form
To print out an Adult Child Enrollment Form, click the following link.
Open Adult Child Enrollment Form

HRA Dependent Enrollment Form
To print out an HRA Dependent Enrollment Form, click the following link.
Open HRA Dependent Enrollment Form

LINKS

Blue Cross Blue Shield Web Site Forms
To access forms from the BlueCross and BlueShield of Nebraska website, including claim forms, please click here.
Open BCBS Web Site Forms

LDI Integrated Pharmacy Services Forms
To access forms from the LDI Pharmacy Benefit Manager website, including claim forms, please click here.
Open LDI

If you have any questions or you wish to request any literature, please call:
(402) 593-7565 or Toll Free: (877) 762-9348

Or, write to us at:

Wilson McShane Corporation
8960 "L" Street, Suite 101
Omaha, NE 68127-1406

Or, E-Mail us at: IBEW Local 22 Benefits