Follow the steps to complete the Ufcw Drug Trust form online.

1. Click ‘Get Form’ button to access the Ufcw Drug Trust form and open it in your document editor.
2. Begin by providing participant information. Indicate whether there has been a change of address by selecting ‘Yes’ or ‘No’. Fill in the participant's first name, middle initial, last name, and date of birth (DOB). Clearly provide the full address including city, state, and zip code. Include the social security number (SSN) or the participant's identification number.
3. If you are filing a claim for a dependent, complete the dependent information section. Check the applicable boxes for gender and relationship status. Provide the dependent's first name, middle initial, last name, and date of birth (DOB).
4. In the certification section, ensure that you read the statements carefully. Your signature is mandatory to process the claim. Sign and date the certification after confirming the truthfulness of the information provided.
5. If you want benefits paid directly to a provider, complete the assignment of benefits section. Sign and date this section to authorize direct payment.
6. If you are submitting for reimbursement, attach any relevant receipts to this claim form prior to submission.
7. The attending physician’s or optometrist’s statement must be filled out by the provider. This includes details on corrective eyewear, delivery dates, and other insurance coverage. Ensure this section is completed accurately.
8. List any charges and services rendered by the provider. This includes types of lenses, examination fees, and the total charges. Make sure to provide accurate billing information.
9. The provider should fill out their certification section, including their tax ID, license number, name, degree, phone number, and mailing address. They must also sign and date this section.
10. Once all sections are completed, review the entire form for accuracy. Save your changes, download, print, or share the completed form as necessary.

Begin filling out your Ufcw Drug Trust form online today for a seamless experience.