Detroit Laborers'

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Forms
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  • Health Care Coverage Election Form

  • Out-Of-Hospital Benefit Claim Form

  • Accidental Injury Questionnaire Form

  • Statement For Loss Of Time Benefits Form

  • Preventive Health Care Program Voucher Form

  • Participant Data Card

  • Change Of Address Form

  • Student Verification Form

  • Authorization And Request To Transfer Employer Contributions Under Reciprocity Agreements


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    6525 Centurion Drive, Lansing, MI 48917-9275
    Phone: 517.321.7502 • Toll-free: 800.228.0048 • Fax: 517.321.7508