• 2023 SPOUSE FORMS
    Updated On: Nov 01, 2022

    Spouse Employment Form

    You must provide information regarding your spouse’s employment status on an annual basis. YES on an annual basis.

    If you do not return the Michiana Area Electrical Workers’ Health & Welfare Fund Spouse Employment Information Form and the Annual Coordination of Benefits Form to the Fund Office in Lansing, Michigan your spouse will be dropped from the Health Insurance as of January 1, 2023 and they will not be able to reinstate until the 1st of the month after forms are received at the Fund Office. 

    This applies only to members who are on the active Anthem Plan. If you and your spouse are on the Humana plan these forms do not apply to you.

    Please complete the Spouse Employment Information Form and the Annual Coordination of Benefits form and return them to the Fund Office by no later than December 28, 2022. Incomplete forms will be returned to the member for additional information.  If your spouse is no longer on your policy and you have not submitted a complete copy of your divorce decree, please include it with your form. You are required to complete and return these forms regardless of your spouse’s employment status. You will receive a confirmation letter in the mail after the Fund Office has received your documents.


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