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New England Health Care Employees Welfare Fund fax number

(860) 947-8080

Membership Department

Used for: Submitting Special Enrollment Form for Covered Spouses (spousal enrollment) and related documents

Fax destination details

Department
Membership Department
Purpose
Submitting Special Enrollment Form for Covered Spouses (spousal enrollment) and related documents
Form
Special Enrollment Form for Covered Spouses — Special Enrollment Form for Covered Spouses
Address
77 Huyshope Avenue, 2nd Floor, Hartford, CT 06106-7001
Voice phone
1-800-227-4744

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Fill out the Special Enrollment Form for Spouses with spouse information; include Spouse’s Employer Affidavit if employed, or an Affidavit in lieu of employment verification notarized if not employed; include supporting documents (e.g., last year's tax return) if required; submit by mail or fax as directed.

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