For IPF:
dstupar@ipfweb.org
Phone: 1-888-880-8222
Fax: 202-347-7339

For IHF:
rdonovick@bacweb.org
Phone: 1-888-880-8222
Fax: 202-383-3905

620 F Street, NW
Washington, DC 20004
202.783.3788

About Us

Summary Plan Description

Gold Plan (PDF)

Silver Plan (PDF)

Bronze Plan (PDF)

 

BAC IHF Health & Welfare Enrollment Form
Download PDF
Fill out & send to:
BAC Health Management Unit
620 F Street, NW
Washington, DC 20004

BAC IHF Insurance Change Form
Download PDF
Fill out & send to:
BAC Health Management Unit
620 F Street, NW
Washington, DC 20004

BAC IHF Affidavit of Common Law Marriage
Download PDF
Instructions: The common law spouse of an eligible participant may be eligible for health and welfare benefits. The health and welfare benefits are governed by the BAC IHF. The Following guidelines also apply:

The participant and common law spouse both must complete and sign the Affidavit of Common Law Marriage. A notary must witness both signatures and an enrollment or change form must be completed to add the common law spouse to existing coverage.

States and commonwealths that recognize common law marriage include the following:

Alabama*, Colorado*, District of Columbia*, Georgia (if created before 1/1/97), Idaho (if created before 1/1/96), Iowa, Kansas, Montana, New Hampshire* (for inheritance purposes), New Jersey (Domestic Partnership for same sex couples. Also opposite sex for 62 or older residing together in New Jersey). Ohio (if created before 10/10/91), Oklahoma, Pennsylvania, Rhode Island*, South Carolina, Texas*, Utah, *denotes IHF participating jurisdictions.

Fill out, sign, notarized, & send to:
BAC International Health Fund
620 F Street, NW
Washington, DC 20004

Employee Reciprocal Authorization and Release
Download PDF
Instructions: Please read all questions carefully and print all answers.
Fill out & send to:
BAC Reciprocal Clearinghouse
620 F Street, NW
Washington, DC 20004

Application for Transition of Care
Download PDF
Instructions: Please read all questions carefully and print all answers.
Fill out & send to:
UnitedHealthcare
PO Box 30562
Salt Lake City, UT 84130-0562