Forms and Documents

Members are protected from surprise medical bills and usually only pay their normal in-network costs.

HIPAA notice explains privacy, rights, uses, disclosures, complaints, and protections for your health information.

Comprehensive health, dental, vision, life, disability, and wellness benefits for Teamsters Security Fund members.

Enrollment form for medical, dental, life insurance; requires personal details, plan selection, authorization, dependents.

What this plan covers and what you pay for covered services.

Coordinated care, savings, support, privacy, wellness, urgent and preventive services.

Voluntary form authorizes release of health information; requires details, purpose, recipient, expiration, and signature.

Choose urgent care, telemedicine, or clinics—avoid ER for non-emergencies to save significant money.

See a provider online. Anytime, from anywhere.

Form for employer, employee, and physician to certify, describe, and authorize a work-related disability claim.

Eligible Active Employees and Non-Medicare Retirees and Dependents describing the self-funded Medical PPO Plan, Dental PPO Plan, Vision PPO Plan and Weekly Accident and Sickness Benefits.

Amendment updates Autism/ABA coverage, clarifies eligibility, increases benefits, and refines operational procedures for members.

Amendment updates weight management program, adds AOMs, clarifies eligibility, coverage, and operational procedures.