EBS Benefit Solutions Participant Services
NYS Teamsters Benefit Fund
Dental Information

Contact Information
For all changes in membership due to:

• change of address
• change of marital status
• when you need to add a dependent to your coverage

contact The Fund Office at:

Phone (315) 455-9790
Fax (315) 234 - 1046
email benefits@nytfund.org

For other questions relating to your dental coverage, and all claim or benefit related questions, please contact EBS Benefit Solutions, Inc. at (800) 803-5773, or (315) 671-7074.

Please submit all dental claims to:
EBS Benefit Solutions, Inc.
P.O. Box 4863
Syracuse, New York 13221-4863

Forms
These forms and brochures are available here in Adobe Acrobat Reader, in a PDF format. If you do not have it, it's free by clicking here.

TPA Dental Membership/Coverage

• TPA Membership Application Form (PDF)
• TPA Membership Information Update Form (PDF)
• Coordination of Benefits Form (DOC)

Claims

• Dental Claim Form (PDF)

Miscellaneous Forms

• Authorization to Release Information (PDF)
• W9 Form (PDF)
• Change of Information Request Form (DOC)

NYS Teamsters Dental Provider Directory (PDF)