Teamsters Local 404 Health Services and Insurance Plan
Trustees
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
Hours
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
Prescription
Reimbursement
Authorization to release PHI
Affidavits
Marital Status
Financial Responbility
Summary Plan Description
Directions to Health Services office
