D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
 
   
        
   
 
 
 
 
   
 
 
 
 
   
 

Transportation Assistance Claim

Use
Use the Transportation Assistance Claim Form to claim for eligible transportation expenses incurred by you or an eligible dependent.


Information Needed to Complete the Form
Your personal Member information is needed to complete the form. In addition:

  • the referring doctor must provide information relating to the referral, and
  • the doctor providing treatment must provide information relating to the visit.

Both doctors must sign the form.



Notes
Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be sent to the Plan Administrator.


 

Form Link
Transportation Assistance Claim Form
 

Related Links
Transportation Assistance Benefit Information
 
 
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