Teamsters Local 639 - Employers Health and Pension Trust Funds

Home > Documents > 401(h) Retiree Health Plan Documents

Employers 401(h) Retiree Medical Plan Documents

401(h) Retiree Health Plan Recent Mailings

	SMM#19 401(h) Cigna Dental EPO Change 06.01.2025

	SMM#18 401(h) Acupuncture Benefit Change 1.1.2025

	SMM#17 02.01.2025 Cigna DHMO Dental Change Notice

	Teamsters-Local639-VSP Micro-Site Flier

	2022 Tax Preparation Notice and SMM#2

	CVS Caremark OTC COVID Test Paper Claim Form

	401(h) 2022 Premium Notice

401(h) Retiree Health Plan Forms

COMING SOON

401(h) Retiree Health Plan Amendments and Changes

	SMM#1_EFF 1-1-2015 401h SPD First Amendment re Spousal coverage

	SMM#2_EFF 1-1-2017 Teamsters Local 639 Retiree 401(h) Clarification of 2017 Composite Rate Notice

	SMM#3_EFF 1-1-2017 Teamsters Local 639 Retiree 401(h) Multiplier and Rates Notice

	SMM#4_EFF 1-1-2018 Teamsters Local 639 Retiree 401(h) New Rates

	SMM#5_EFF 3-1-2018 Teamsters Local 639 Retiree 401(h) Opioid Notice

	SMM#6_EFF 3-1-2020 Teamsters Local 639 Retiree 401(h) Dental and Vision Benefit Changes

	SMM#7_EFF 3-18-2020 Teamsters Local 639 Retiree 401(h) COVID-19 Health Plan Notice

	SMM#8_Eff 3-18-2020 Teamsters Local 639 401(h) SECOND COVID-19 Health Plan Notice

	SMM#9_401(h) Extended Telehealth Visits

	SMM#11_401(h)Eff 1-1-2022 Teamsters Local 639 Retiree 401(h) Plan Improvement and Changes

	SMM#12 401(h)_OTC COVID19 Test Kit Notice

	SMM#13_401(h) Mammograms_OTC COVID and TeleHealth

	SMM#14_401(h) End of National Emergency

	SMM#15_EFF 06-01-2024 Occupational Therapy Benefit

	SMM#16_Eff. 01-01-2025 Specialty Drug Change

	SMM#17 02.01.2025 Cigna DHMO Dental Change Notice

	SMM#18 401(h) Acupuncture Benefit Change 1.1.2025

	SMM#19 401(h) Cigna Dental EPO Change 06.01.2025

401(h) Retiree Health Plan Health Care Documents and Summary Plan Description

Teamsters Local 639 HIPAA Notice of Privacy Practices 2-2026