Click a form link below to download in PDF format:
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Member Services:

• Change of Beneficiary Form
• Full-Time Student Status Form
• Request for Additional Information/Possible Third Party Claim Form
• Change of Address Form
• Health Bonus Account Claim Form
• Medical Program Option Change Form 2009
• New Smoking Cessation Form

Retirees:

• Automatic HealthCare Deduction for TeamstersCare Retirees Form

• Prescription Drug Direct Payment Claim Form
• Pharmacy Credit/Debit Card Authorization for Pharmacy Mail-in Copay Form
• TeamstersCare Medication Prior Authorization Request Form
• Prescription Drug Refill Form
• Lipitor Pill Splitting Program Form