Forms - Level B

Enrollment Forms

If you have been notified that you are eligible for benefits, please print and complete this form. Enrollment forms are accepted at the Administrator's office at Open Enrollment (November 20th through December 20th). NOTE: Submitting an enrollment application is not proof of enrollment.

General Forms

Prior to obtaining vision benefit through MES Vision complete the MES Vision Claim form. Give this form to your vision provider at the time services are rendered. You must have met the Fundís eligibility and enrollment requirements in order to obtain covered services.

All eligible participants are enrolled in Life Insurance. Please print and complete this form to designate a beneficiary.

If you have been notified that you are eligible for benefits, but have decided not to enroll, print and complete. Upon certain conditions you may reserve your and your dependent’s right to enroll at a later date.

Submitting Forms

Claim forms should be sent to the appropriate benefit provider at the address listed on the form.

All other forms should be sent to:

Musicians Health and Welfare
c/o PacFed Benefit Administrators
1000 N. Central Avenue, Suite 400
Glendale, California 91202
Level A Level B Level C contact us