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
E-mail the fund office

For other questions relating to your dental coverage, and all claim or benefit related questions, please contact EBS-RMSCO, Inc.

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

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

Claims

• Dental Claim Form (PDF) 

Miscellaneous Forms

• Authorization to Release Information (PDF) 
• Change of Information Request Form (PDF) 
• W9 Form (PDF) 
NYS Teamsters Dental Provider Directory (PDF)

NYS Teamsters Benefit Fund

• About Us
• Services Provided
• Contact Us
• Office Locations