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
SMM - dated January 1, 2026
2026 Enrollment Form for New or Reinstated Coverage
2026 Newborn Enrollment Form
2026 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