Teamsters Local Union No. 301
Health & Welfare Fund
and Pension Fund
Questions?
Contact the Fund Office
(847) 623-5430 - Pension & Health Eligibility
(847) 623-3915 - Medical Claims
CLICK FOR FORMS
Forms and Notices - Health & Welfare
Forms
Pension Forms
Pension Beneficiary Form
Retirement Application Request Form
Health & Welfare Forms
2025 Enrollment Form for New or Reinstated Coverage
2025 Newborn Enrollment Form
2025 Special Enrollment Form
Dependent Affadavit Form for Natural Parent
Dependent Affadavit Form for Step Parent
H&W Beneficiary Form
HIPAA Privacy Authorization Form
Retiree and Spouse Medical Plan Certification Form
Retired Spouse Only Medical Plan Certification Form
Short Term Disability Application