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NY United Federation of Teachers SHIP Claim Form 2012 free printable template

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Claims must be filed within 1 year of the date of service or payment by health plan, whichever is later SHIP Claim Form FT/RTC Supplemental Health Insurance Program (SHIP) Mail to: SHIP P.O. Box
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NY United Federation of Teachers SHIP Claim Form Form Versions

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NY United Federation of Teachers SHIP Claim Form 2022
4.8 Satisfied (102 Votes)
NY United Federation of Teachers SHIP Claim Form 2012
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NY United Federation of Teachers SHIP Claim Form 2010
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How to fill out NY United Federation of Teachers SHIP Claim

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How to fill out NY United Federation of Teachers SHIP Claim Form

01
Obtain the NY United Federation of Teachers SHIP Claim Form from the official website or your local union office.
02
Fill out your personal information at the top of the form, including your name, address, and member ID.
03
Provide details about the healthcare provider, including their name, address, and phone number.
04
Enter the date of the service you received.
05
Specify the type of service or treatment you received.
06
Attach all relevant documentation, such as itemized bills and Explanation of Benefits (EOB) from your insurance company.
07
Review the completed form for accuracy and completeness.
08
Sign and date the form to certify that the information is true and correct.
09
Mail the completed form along with all attachments to the address specified on the form.

Who needs NY United Federation of Teachers SHIP Claim Form?

01
Members of the NY United Federation of Teachers who have incurred out-of-pocket medical expenses and wish to file a claim for reimbursement.
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Starting in 2022, your dental stipend has increased to $400 per year. If you have paid out of pocket at least $400, the SHIP will reimburse you $400. Here are some helpful links: Supplemental Health Insurance Program (SHIP) benefit letter.
SHIP provides a benefit of $10,000 for accidental loss of life or loss of both limbs or both eyes. SHIP provides a benefit of $5,000 for accidental loss of one limb or one eye. Benefit expires at age 80, NO benefits paid for self-inflicted injuries.
UFT retirees will receive an Optional Rider reimbursement at the beginning of March. This year's reimbursement is $840 for retirees whose Optional Rider or health plan deduction was in effect for all of 2022.
Shipping insurance can cover loss or damage up to the insured value of the goods, plus shipping costs. Your policy can be tailored to your business's needs based on the goods you ship, how you ship and the carriers you use, as well as include coverage for high-value, fragile, time-sensitive or perishable goods.
If eligible, your health benefits continue to be provided by NYC for you and your eligible dependents, including children under the age of 26.

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The NY United Federation of Teachers SHIP Claim Form is a document that members use to file claims for reimbursements related to health insurance or other eligible benefits under the School Health Insurance Plan (SHIP).
Members of the NY United Federation of Teachers who are enrolled in the School Health Insurance Plan (SHIP) and wish to seek reimbursement for eligible health expenses are required to file this claim form.
To fill out the NY United Federation of Teachers SHIP Claim Form, members need to provide their personal information, details of the expenses incurred, any supporting documentation (such as receipts), and sign the form to certify the accuracy of the information provided.
The purpose of the NY United Federation of Teachers SHIP Claim Form is to enable members to submit claims for reimbursement of eligible medical expenses under the SHIP program, ensuring that they receive the benefits they are entitled to.
The information that must be reported on the NY United Federation of Teachers SHIP Claim Form includes the member's name, identification number, details of the medical services received, dates of service, total amounts charged, and any insurance reimbursement already received.
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