Teamsters Joint Council No. 83 of Virginia
Health & Welfare and Pension Funds
Health and Welfare Forms
Click on any of the forms below to download it. The Fund accepts all forms via mail, email or fax. If you do not have a PDF viewer, you may click on the Adobe icon to download Adobe Reader.
- » ADA Dental Claim Form
- » Anthem Claim Form
- » CarelonRx Mail Order Form
- » CarelonRx Reimbursement Form
- » Change of Address Form
- » Change of Beneficiary Form
- » Coordination of Benefits (COB) for Natural Parents
- » Coordination of Benefits (COB) Yearly Update Form for Participant
- » Coordination of Benefits (COB) Yearly Update Form for Qualifying Child
- » Dependent Information Form
- » Dependent SSN Request Form
- » Designation of Authorized Representative Form
- » Disability Claim Form
- » Disability Continuance Form
- » Dismemberment Claim Form
- » EFT Form (STD)
- » Enrollment Form
- » Glossary
- » Injury Report Form
- » Insurance Verification Form
- » Marital/Divorce Status Form
- » PHI Release Authorization Form
- » Qualifying Child Enrollment Form
- » Retiree Insurance Verification Form
- » Retiree Group Insurance Inquiry
- » Student Verification Form
- » Workers Compensation Form