View or download the Green Apple guide to UFT Welfare Fund health benefits for in-service members and their families.

Have you had to work beyond your regularly scheduled work day within the past 30 school days? If so, please provide us with specific details of what happened, when it happened, what if anything you did to try to rectify the problem, if you were...

Although the cost of anesthesia for hospitalization, emergency illness or accidental injury should be covered in full by HIP/HMO, the Welfare Fund will pay 80% of reasonable, usual and customary charges when not covered by HIP/HMO.

Your doctor must fill out this form at regular intervals — usually every 4-6 weeks — during your convalescence. It is used to determine your level of benefits — so it is very important that your doctor fills it out carefully.

Step Therapy is a program especially designed for people who take prescription drugs regularly to treat ongoing medical condition(s). The program is a new approach to getting you and your family the prescription drugs you need.

Use the forms in this package to report occupational exposure incidents. Exposure incident means a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that results...

Legal referrals injury claim form

Injured employees should submit this form within the first seven calendar days of absence due to injury sustained in the performance of official duties.

Pedagogues and paraprofessionals use this form to apply for a retirement leave of absence. For every two days in the employee’s sick bank, one day of terminal leave is granted. The form must be filed 30 days in advance of the leave. The leave can...

Electronic Fund Transfer (EFT) is a payment system that allows TRS retirees and beneficiaries receiving lifetime benefits to have their monthly Qualified Pension Plan (QPP) and/or Tax-Deferred Annuity (TDA) Program payments electronically transferred...

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...

Educational paraprofessionals should use this form for initial requests for leaves of absence as well as requests for extensions. Requests for extensions must be submitted prior to the date of expiration of the current leave.

Please complete this form if you would like to cancel the Electronic Fund Transfer (EFT) or Direct Deposit of one or both of the following: a) your monthly retirement allowance under the Qualified Pension Plan (QPP); or b) your monthly annuity...

Please file this form only if you meet one or both of the following conditions: You are receiving Qualified Pension Plan (QPP) and/or Tax-Deferred Annuity (TDA) payments from TRS through Electronic Fund Transfer (EFT); and The account number at your...

The UFT Health & Safety Department offers workshops on health and safety issues on staff development days, union meetings, etc. If you would like to have one of these workshops offered to your chapter, please fill out this form and send it to the...

Frequently asked questions about the DOE's salary application system.

Fill out and have this affidavit notarized to cover unmarried children over age 26 who cannot support themselves because of a mental illness, developmental disability, mental retardation or physical handicap under the UFT Welfare Fund Benefit Plan....

This form is used to request a correction or duplicate W-2 for the current tax year and/or the three previous years. Requests for earlier W-2s are handled by the Office of Payroll Administration or the Office of Employment Records Research.

Include all original pharmacy receipts with prescription detail clearly noted which must include the name, strength, quantity and price. Please attach to this form. Receipts must be mailed within 90 days from date of service. Reimbursement will be in...

This form allows health care providers who have treated your previous injuries to release information to your employer’s workers’ compensation insurer.

Use this confidential form to notify the UFT School Safety Department if you have been the victim of an incident and/or injury. Or fill out the online incident report form.

The Affordable Care Act requires group health plans to provide a Summary of Benefits and Coverage (SBC) to plan participants so they may better understand their coverage. In compliance with this law, the UFT Welfare Fund has completed an SBC...