Teamsters Local 404 Health Services and Insurance Plan


Frank A. Rossi                   Robert M. Sullivan, Jr.

Victor Santiago                 Larry Keefe 


115 Progress Avenue

Springfield, MA 01104

 Phone: 413-733-2191 

Phone: 800-851-3002

Fax:      413-746-9094


Monday - Friday

      8:30 a.m. - 4:30 p.m.

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



Authorization to release PHI 


Marital Status

Financial Responbility

Summary Plan Description

Directions to Health Services office 

Business Meeting

Summary Annual Report

Residence Spouse as of a date

Residence Spouse 

Residence Dependent


Please contact  Local 404 Health Services office for questions concerning eligibility,  benefits and claim payment.