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IBEW 613 Secure Upload

Newly Enrolled Dependents for 2021

You must provide the following documentation for new dependents you are enrolling in the IBEW Local 613 and Contributing Employers Family Health Plan.

Natural Child: Birth Certificate and Social Security Card.

Adopted Child: Adoption paperwork which lists adoptive parents,

Spouse: Marriage Certificate, Social Security Card and Employer-Sponsored Health Coverage Verification Form.

The Fund Office will advise you if additional documentation is needed.

Fields below marked with an asterisk (*) are required. You may send files up to 18 MB in size, in the following formats: Thank you!

Image Formats: JPEG, JPG, GIF, PNG, BMP
Portable Document Format (PDF)

Use the “Browse” buttons to select your file for upload. Once you have attached the files you wish to upload, click the “Submit” button to complete your submission.