Teamsters Local 677 Health Services and Insurance Plan

Trustees

 John  P. Capobianco         Paul Ayoub

 Michael J. Rinaldi              Helga A. Schmidt

1871 Baldwin Street

Waterbury, CT 06706

 Hours

Monday - Friday

   8:00 a.m. - 5:00 p.m.

Phone: 203-755-2906

Phone: 800-992-2250

Fax:      203-755-3992

Please return your 2020 Annual Information Request form 

Please show your ID card to the health care provider

      Your id starts with TSJ followed by 7 numbers.

          

Important information is located on back of card

           Fill in forms to print and mail  

The below forms are here for your convenience. Please contact your Local Fund office first when submitting a claim or providing information.

Medical Massage Reimbursement

 Prescription

Reimbursement

Reimbursement lien agreement 

Authorization to release PHI 

Affidavits

Marital Status

Financial Responsibility

Summary Plan Description

Residence Spouse as of a date

Residence Spouse 

Residence Dependent

Paternity

Business Meeting

Summary Annual Report

Directions to Health Services office 

Please contact  Local 677 Health Services office for questions concerning eligibility,  benefits and claim payment.