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Teamsters Local 404 Health Services and Insurance Plan


    Frank A. Rossi                   Robert M. Sullivan, Jr.

    Bryan Donovan Jr.            Larry Keefe 


115 Progress Avenue

Springfield, MA 01104


Monday - Friday

      8:30 a.m. - 4:30 p.m.

 Phone: 413-733-2191 

Fax:      413-732-7147

Please watch your USPS mail for important plan information

Please return your 2024 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



Authorization to release PHI 


Marital Status

Financial Responbility

Residence Spouse as of a date

Residence Spouse 

Residence Dependent


Directions to Health Services office 

Summary Plan Description

Business Meeting

Summary Annual Report

Paper Claims Address:

Teamsters Health Services Local 404

115 Progress Avenue

Springfield, MA 01104

PAY ID #06085

GROUP # JCT048M003

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

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