Labor Alliance Managed Trust Fund
P.O. Box 757
Pleasanton, CA 94566
If you do not have access to a printer, you can contact the Plan Administrative Office at (800) 924-1226 to request that a form be mailed to you.
Please note that if you are in the process of enrolling a new dependent under your health and welfare plan, and the dependent has a different last name than your own, you will need to provide proof of the dependent’s eligibility through submission of a copy of the appropriate, certified documents (i.e., a marriage certificate for a spouse/birth certificate for a child).
Retiree Provider Forms
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