Forms

Prescription Drug Reimbursement Form
Medco-Pharmacy Mail-Order Form
Dental Claim Form
Disability Claim Form
CHILD CARE REIMBURSEMENT FORM
Childcare - Affidavit for Service from an Unlicensed Provider or Relative--Revised
Childcare - Affidavit for Service from an Unlicensed Provider or Relative--Revised
Childcare - Affidavit for Service from an Unlicensed Provider or Relative--Revised
Benefits Enrollment Card
Charles Ensley Educational Fund Claim Form
Supervisor in Field Instruction (SIFI)
ANNUITY FUND TAX NOTICE 2020 NEW
ANNUITY FUND DISTRIBUTION ELECTION FORM
ANNUITY-FD-DESIGNATION-OF-BENEFICIARY-FORM
Multi-Benefits Claim Form

SSEU Local 371 Welfare Fund

Downloadable Forms

1095-B TAX FORMS-2025

1095-B Tax forms are available to members upon request. 

To obtain a copy of your 2025 1095-B form, please email the Funds or contact us in writing.

E-mail: welfarefund@sseu371funds.org

cONTACT US

  • 1501 Broadway, Suite 450, New York NY 10036
  • +1 212-777-9000
  • welfarefund@sseu371funds.org

Social Networks

NAVIGATION

SSEU Local 371 Welfare Fund