Teamsters Local 22

Health and Welfare

Pension

Additional Information

Dental Fee Schedule

 Pension Schedule

COBRA

Health and Welfare Plan Schedule

Creditable Coverage

Retiree Dental Schedule (ZR)

Disqualifying Employment Rules

Retiree Plan Schedule (ZR)

Request new/additional insurance cards

Retiree Health Coverage Eligibility Rules

Health and Welfare Forms

Pension Forms

Retiree Health Coverage Premium

Change of Address Form

Beneficiary Designation

Change of Beneficiary Form

Contingent Annuitant Election Form

COB Yearly Update (Participant)

Early Vested Benefit Election/Rejection Form

COB Yearly Update (Qualifying Child)

Early Survivor Benefit Election/Rejection Form

Dependent Form

Electronic Funds Transfer Form

Dependent Eligibility Certification Form

Joint and Survivor Election Form

Dependent SSN Request Form

Joint and Survivor Rejection Form

Disability Claim Form

Pension Application

Disability Continuance Form

Post-retirement Approval Form

Enrollment Form

Post-retirement Employment Form

Injury Report

Retiree Coverage Insurance Inquiry

Insurance Verification Form

VA-4 State Tax Withholding Form

Marital/Divorce Status Form

W-4 Federal Tax Withholding Form

Pre-existing Condition Form

Qualifying Child Enrollment Form

Rx Solutions Mail Order Form

Rx Solutions Reimbursement Form

Retiree Insurance Verification Form

Student Verification Form