Forms


1095-B Notice

Participants may receive a copy of their 2020 Form 1095-B upon request.

Contact the Sheet Metal Workers’ Local 46 Benefits Office: 244 Paul Road, Rochester, NY 14624, Call 585-458-0400 or email beneftis@smw46.com to request your form 1095-B.

Claim Forms Applications for Distribution Miscellaneous

Excellus Dental Claim

Excellus Medical Claim

Davis Vision Claim

Envision Claim

Lifetime Benefits Solutions HRA

Contact the Benefit Office for information
on your Benefit Form choices.

Rollover Retirement Distribution Forms

Special Termination Benefit Distribution Forms

Death Benefit Distribution Forms

Education Benefit Distribution Form

Hardship Benefit Distribution Forms

Normal Termination Benefit Distribution Form

Change of Address Form

Beneficiary Designantion Form

Family Member Authorization Form

Retiree Tax Withholding Form

Privacy Notice

Health Notice

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