top of page
Teamsters Local 404 Health Services and Insurance Plan
Trustees
Stanley J. Osowski Robert M. Sullivan, Jr.
Frank Rossi Larry Keefe
115 Progress Avenue
Springfield, MA 01104
Hours
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 2025 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
Residence Spouse as of a date
Residence Spouse
Residence Dependent
Paternity
Directions to Health Services office
Summary Plan Description
Summary Annual Report
Paper Claims Address:
Anthem Dental Claims
P. O. Box 659444
San Antonio, TX 78265-9444
PAY ID #84105
GROUP # JCT048D025
Please contact Health Services office for questions concerning eligibility, benefits and claim payment.
bottom of page