IUPAT LOCAL 177 HEALTH
AND PENSION TRUST FUNDS
Consent to Release Version 1.0
Electronic Funds Transfer (EFT) Authorization for Claim Payments Version 1.0
Guide to Applying for Freezing of Hours Version 1.0
Guide to Applying for Weekly Disability Benefits Version 2020
Health Spending Account Claim Form Version 1.0
Pre-Determination - Hospital Bed Assessment Form Version 2017
Pre-Determination - Knee Brace Version 2017
Pre-Determination - Nursing Care Assessment Form Version 2017
Pre-Determination - Oxygen Concentrator Assessment Form Version 2017
Pre-Determination - Wheelchair Assessment Form Version 2017
Prescription Drug Special Authorization Request Form Version 1.0
Consent to Release Version 1.0
Electronic Funds Transfer (EFT) Authorization for Claim Payments Version 1.0
Guide to Applying for Freezing of Hours Version 1.0
Guide to Applying for Weekly Disability Benefits Version 2020
Health Spending Account Claim Form Version 1.0
Pre-Determination - Hospital Bed Assessment Form Version 2017
Pre-Determination - Knee Brace Version 2017
Pre-Determination - Nursing Care Assessment Form Version 2017
Pre-Determination - Oxygen Concentrator Assessment Form Version 2017
Pre-Determination - Wheelchair Assessment Form Version 2017
Prescription Drug Special Authorization Request Form Version 1.0
Registration in the Ellement app (web)
Ellement app
Create your username and password in the web app to register and submit claims electronically.
What you'll need
As a first-time Ellement Group Benefits user, you must register your account. For this, you will need your new benefit card, as in the registration process, you must provide your Group Number and Certificate Number found on your benefit card:
Create your username and password, and log in
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Click Register in the top right corner.
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Enter the information requested, and create a username and password.
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Click Register.
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You will see the login page again, but now you can enter the username and password you just created.
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Click Log in at the bottom.
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You will now see the dashboard. Here, you can see recently submitted claims and the status of your submitted claims.
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.
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You will see the login page again, but now you can enter the username and password you just created.
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Click Log in at the bottom.
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You will now see the dashboard. Here, you can see recently submitted claims and the status of your submitted claims.
Step 2 - click Register
Step 3 - complete the form
Step 5 - login with new credentials
Step 7 - dashboard