Local 567 Members,

It is time to verify your dependents for The Employee Painters Trust Health and Welfare. You should have received by mail a dependent verification form. This form must be completed and turned back into the Trust fund by February 6, 2023. If you do not verify your dependents, they will be terminated and future claims for your dependents will not be paid until you have verified the information.

This form is simple to complete. Please review your listed dependents, mark if they are eligible or not. Dependents who do not meet the definition of an Eligible Dependent (eligible dependent examples are: your legal spouse, your children including stepchildren and adopted children – from birth up to the end of the month in which they turn 26), the ineligible Dependent will need to be removed from the Employee Painters’ Trust Health and Welfare benefit plan as soon as administratively possible. You will need to provide the date in which they are/were no longer considered an Eligible Dependent (the Termination Date). And Please upload a statement explaining why the Dependent is ineligible. In case of divorce, or termination of parental rights, upload a copy of any relevant court paperwork.

Once completed please submit the form, you have options:

1. Online: www.IUPATWesternBenefits.org and login. Click on Member Benefits and follow the instructions to complete the member verification.
2. Regular mail: mail back in the enclosed blue self-addressed envelope that was included with your verification form.

Employee Painters’ Trust
Attention: Eligibility Department
Koll Center Parkway, Suite 200
Pleasanton, CA 94566

3. Email: email the completed form to depaudit@iupatwesternbenefits.org

Should you have questions or need assistance please contact the Trust office at (206)518-9730 or 1(844)344-2721