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Fillable SHIP Claim Form - uft

Description

Please read reverse side for limitations and required documentation needed to submit a claim Claims must be filed within 1 year of the date of service or payment by health plan, whichever is later SHIP Claim Form UFT/RTC Supplemental Health Insurance Program (SHIP) Mail Claim Form to: SHIP P.O. Box 390 Bowling Green Station New York, NY 10274-0390 Telephone: (212) 228-9060 Member's Last Name First Name...
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