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Michiana Area Electrical Workers
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Forms
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  • Beneficiary Designation Form

  • Blue Cross Blue Shield of Michigan Enrollment / Coordination of Benefits Form

  • Change of Address Form

  • Direct Debit Authorization Form

  • Pension Deduction Authorization Form

  • Supplemental Benefit Account Reimbursement Request Form

  • Student Verification Form

  • Medco Mail Order Drug Form

  • Statement for Loss of Time Benefits Form

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    Michiana Area Electrical Workers Benefits Web Site
    6525 Centurion Drive, Lansing, MI 48917-9275
    Phone 877.244.9473 • Fax 517.321.7508


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