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How to Join

Find Your Path Forward

The IAFF Health & Wellness Trust is available to collectively bargained IAFF Participating Locals working for a public employer. If you would like to learn more but are not ready to request a proposal, please complete the required fields below and submit. If you are ready to request a proposal, please complete the entire form and the Trust Consultant will work with you to create a proposal for your Local.


How to Join

Questionnaire and Information Request

State
Primary Contact Name(Required)
MM slash DD slash YYYY

Current Plan Information

MM slash DD slash YYYY
Current Healthcare Contributions (Employer and Employee contributions):
(% or $)
(% or $)
(% or $)
(% or $)
How many employees (approx.) fall into each of the following categories? (If composite rate, use line 6.)
Are retirees currently covered on your Employer-sponsored plan?

Please send the following documentation for all plans for which you would like to receive an IAFF HWT pricing proposal with your response:

Census – Employees and Dependents including:
  • Date of Birth
  • Gender
  • Zip Code
  • Employment Status
  • Coverage Type (Employee only, Employee & Spouse, Full Family, etc)
Max. file size: 10 MB.
Max. file size: 10 MB.
Max. file size: 10 MB.
Max. file size: 100 MB.
Max. file size: 10 MB.
Max. file size: 10 MB.
Max. file size: 10 MB.
Please don’t hesitate to contact the Trust Consultants at DiMartino Associates with any questions or concerns about this Questionnaire.
This field is for validation purposes and should be left unchanged.