1199SEIU 9NBF4A 2016-2025 free printable template

ENROLLMENT CHANGE FORM Formulario de de Matricula This form is not valid for your initial enrollment in the 1199SEIU Benefit Fund Este formulario no es valido para la primera matricula en el Fundo de Beneflcio de 1199SEIU THE FUND CANNOT BE RESPONSIBLE FOR ORIGINAL RECORDS - ONLY SEND PHOTOCOPIES EL FONDO NO ES RESFONSABLE POR ARCH/VOS ORIGINALES - INCLUYA COPIAS PRINT CLEARLY 1N 1NK EscRtBA coN nNrA EN LETRA DE MOLDE Member Eligibility Dept. P. O. Box 1035. New York NY 10108-1035 www....

How to fill out 1199 seiu enrollment change form

How to fill out 1199SEIU 9NBF4A

1. Obtain the 1199SEIU 9NBF4A form from the official 1199SEIU website or your union representative.
2. Carefully read the instructions provided with the form to understand the requirements.
3. Fill out the personal information section, including your name, address, union membership ID, and contact information.
4. Complete the employment information section, providing details about your employer and job title.
5. If applicable, indicate any additional relevant information requested in the form, such as work hours or special conditions.
6. Review your completed form for accuracy and make any necessary corrections.
7. Sign and date the form at the designated area.
8. Submit the completed form to your union representative or the address indicated in the instructions.

Who needs 1199SEIU 9NBF4A?

1. Members of the 1199SEIU union who require benefits or services provided under the 9NBF4A agreement.
2. Healthcare workers seeking specific support related to their employment.
3. Individuals who need to file for benefits that are available to them as part of their union membership.

Video instructions and help with filling out and completing 1199 enrollment change form

Instructions and Help about 1199 seiu enrollment change form trial

Hello I'm Staff Sergeant Travis Reed, and today I'm going to go over with you how to fill out the DD two six five six which is simply your retirement application form this is a two part form, so this video will seem a little longer however it is worth your time in section one pay identification you have blocked one name this is in last name first name middle initial format so for me, it would be read comma Travis space J the next block moving to the right is SSN which is simply your social security number with or without dashes the next block is block 3 retirement slash transfer date this will be the same date that you put on the DD Form 108 which will be the date you turn 60 or the RPE d date retirement pay eligibility date and block 4 to the right you have rain pay grade this will be for myself Staff Sergeant which is SSG backslash e6 the next base to the right is date of birth and that is year month date format back to the left you have six correspondence address again this will be wherever you receive your mail be it a physical address or P o box so in 6a you have Street or P o box 6b you have the city 6c you have the state which is abbreviated 6d you have the zip code and 6e you have the telephone number ensure that you put your area code in section 2 you have direct deposit / electronic fund transfer information so in section 2 seven you have your routing number every routing number will have nine digits ensure that you have nine digits in your routing number moving to the right you have blocked 8 type of account this will be checking or savings if you decide to use a money market account put s for savings moving over to the right you have 9 account number this will be simply your account number ensure that you use all the numbers and double-check your work going back to the left you have the financial institution in number 10 so 10 an is the financial institution name I use State Employees Credit Union, so I will use ecu as the abbreviation 10 B is the street address 10 C the city 10 D the state again abbreviated and 10 e the zip code in section 3 you have separation payment information this information is simply in the form of a yes or no answer and depending on your answer will determine if you have to put anything in Block B and C so in section 3 separation payment information 11 a question is this did you receive severance pay readjustment phase separation paid voluntary separation incentive or special separation bonuses if you did not you will put an X in the no block, and you will not have to fill out B or C type of payment and gross amount if you did receive this payment you will put an X in the yes block you'll put in Block B the type of payment by the abbreviated format so if it is a severance pay it will be SC if it was a readjustment pay it will be RP if it was a separation pay it will be SP if it was a voluntary separation incentive you will put V is and if it was special separation bonus it will be SS b and black C you will...

People Also Ask about 1199seiu 9nbf4a pdf

What does 1199 insurance cover?

More than 200,000 members of 1199SEIU have won comprehensive healthcare coverage — hospitalization, doctors' visits, dental and vision care, prescription drugs, etc. — with no or minimal out-of-pocket expenses for themselves and their families. In all, the benefit covers more than 450,000 lives.

What are the spousal benefits for a pension?

The spousal benefit can be as much as half of the worker's "primary insurance amount," depending on the spouse's age at retirement. If the spouse begins receiving benefits before "normal (or full) retirement age," the spouse will receive a reduced benefit.

Does 1199 have a deductible?

What is the overall deductible? $0 See the Common Medical Events chart below for your costs for services this plan covers.

What is member ID on 1199 insurance card?

Do you have an 1199SEIU Member ID? Your Member ID is a ten-digit number beginning with "9" that appears on your Health Benefits ID card.

Does 1199 cover spouses?

Paid Family Leave Benefits may be used when you are unable to work due to the following Qualifying Events: fi months of birth or placement. members include spouse, domestic partner, child, parent, parent in-law, grandparent and grandchild. Self-care is excluded.

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What is 1199SEIU 9NBF4A?

1199SEIU 9NBF4A is a specific form utilized by the 1199SEIU United Healthcare Workers East, a labor union representing healthcare workers in various sectors for reporting and compliance purposes.

Who is required to file 1199SEIU 9NBF4A?

Members of the 1199SEIU union and employers in the healthcare industry who are bound by the union's contracts are typically required to file the 1199SEIU 9NBF4A.

How to fill out 1199SEIU 9NBF4A?

To fill out the 1199SEIU 9NBF4A, individuals need to provide accurate personal identification information, employment details, hours worked, and contributions made as outlined on the form's instructions.

What is the purpose of 1199SEIU 9NBF4A?

The purpose of 1199SEIU 9NBF4A is to ensure proper reporting of wages and hours for the purpose of calculating benefits and contributions owed to the union.

What information must be reported on 1199SEIU 9NBF4A?

The information that must be reported on 1199SEIU 9NBF4A includes employee identification, hours worked, wage rates, contribution amounts, and any deductions applicable under union agreements.