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Enrollment Form for Adult Children DUE PRIOR to Jan.1, 2012 (click here for more) - (10/27/2011)

This enrollment form applies to all adult children ages 19-26 whom you wish to enroll in or continue to be covered under the Local 580 Insurance Fund. Enrollment for your adult child will be requested by the Fund Office annually. Feel free to download the form should you need additional forms or contact the Fund Office at (212) 695-5206.

Coverage will not be effective until the first of the month after the month in which the Fund Office receives the completed material. In addition, no claims will be paid for the periods during which the adult child was not properly enrolled.

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