Dental

Dental Claim Form

After you have read the dental claim form instructions (below) you are ready to fill out the dental claim form as needed.


Declination of Welfare Fund Benefits - Dental and/or Vision

Use this form to decline Welfare Fund dental and/or vision benefits for yourself and eligible dependents. You must sign this form and have it notarized.

Use this form to decline Welfare Fund dental and/or vision benefits for yourself and eligible dependents. You must sign this form and have it notarized.

Dental Schedule

For Welfare Fund members who are using a non-participating dentist, your reimbursement will be according to this dental fee schedule; for those using a participating dentist, there will be no cost to the member except for co-pays listed in this schedule for a few services.


Directory of Participating New York Area Dentists

Participating Dentist Program, Sept. 2012. Administered by SIDS.

Healthplex Dental Plan Schedule

Schedule of benefits for the UFT Florida Dental Discount Plan administered by Healthplex.

Healthplex Dental Plan Providers

List of participating providers for the UFT Florida Dental Discount Plan, administered by Healthplex.

Florida PPO Dental Directory

If you or a member of your family who is covered by our dental benefits wish to use a Participating Dentist, select one from this Directory and call for an appointment.


Direct Access Dental Plan

This fully explains the benefits available under the UFT Welfare Fund Direct Access Dental Plan (SIDS – Self-Insured Direct Services) and includes a subscription form at the end.


Dental Enroll/Transfer Form

As a new member you are automatically enrolled in the Scheduled Benefit Plan. If you wish to enroll in one of the other UFT Welfare Fund dental options use this form. All other members and retirees who wish to transfer from one UFT Welfare Fund dental plan to another can do so annually from Sept. 1 – Oct. 15, using this form. The new plan becomes effective Nov. 1.


Dental Claim Form Instructions

These instructions explain how to fill out your dental claim form either after treatment or for pre-treatment estimates for more complicated procedures such as periodontic surgery, bridges, crowns, inlays, dentures and other procedures that cost over $500 in a 90-day period.


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