United Food and Commercial Workers Union Local 152 Health and Welfare Fund fax number

Fax destination details

Department

Fund Office

Purpose

Submitting Enrollment & Coordination of Benefits (COB) forms and related HIPAA authorization documents to the Fund Office; COB notifications and enrollment updates are typically returned by fax.

Form

Enrollment & COB Form (Adult Child Enrollment & COB) — Adult Child Enrollment & Coordination of Benefits (COB) Form

Address

27 Roland Avenue, Suite 100, Mount Laurel, NJ 08054

Voice phone

(856) 793-1598; Toll-free (800) 555-4959

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete the Enrollment & COB form with participant and adult child information; attach required documents (for example, birth certificate for the adult child; if you have a stepchild, provide the marriage certificate showing the child's parentage; for adopted children, provide court documentation). Fax the completed form to the Fund Office at 856-793-3100.

Official form instructions are published as a downloadable file on the organization's website.