You can choose a personal representative(s) to share your health information with by filling out this form.

You may authorize the UFT to use/disclose your protected health information by filling out this form.

For HIP subscribers only, use this In-Hospital Private Duty Nursing Claim Form for the UFT Welfare Fund to cover the costs, after a 72-hour deductible, of 80% of the usual and customary costs of in-hospital services provided by a registered nurse...

This price waiver form must be completed by both the member and his/her physician in cases where a brand rather than generic prescription is deemed medically necessary.

For members: this notice has information about your current prescription drug coverage with the UFT Welfare Fund and your options under Medicare’s prescription drug coverage. Please read carefully.

This form is for retired members who have elected a New York City optional rider or New York City health plan, or are covered under their spouse’s/domestic partner’s NYC health plan.

This form is for retired members who have elected a non-New York City optional rider for health insurance or prescription plan, or are covered under their spouse’s/domestic partner’s non-NYC health plan.

For HIP subscribers only, includes a section for member and physician to fill out. Please attach original, itemized, paid bill showing date and item purchased.

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...

DOE Labor Policy Guidance on workday times, parent-teacher conference dates and contractual remote work for school-based titles.

Annual DOE list of teacher license area shortages which may qualify members licensed in these areas for additional compensation.

Extended Use Training PowerPoint presentation for School Secretaries

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.

Members on an approved Child Care Leave who are currently covered by the UFT Welfare Fund are eligible to receive extended UFT Welfare Fund benefits for up to a maximum of six (6) consecutive months for the birth or adoption of a child.

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...

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...

Fill out and have this form notarized for your dependent child to ensure coverage by the UFT Welfare Fund benefit 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.

Chancellor's Regulation A-832: This regulation establishes a procedure for the filing, investigation, and resolution of complaints of student-to-student discrimination, harassment, intimidation, and/or bullying.

Use this form to file a claim if your eyeglasses were damaged in an assault.

Teacher's Choice participants use this form to inform their school principal of purchases made with Teacher's Choice funds. Once completed, attach all original receipts/invoices and submit to your school principal for review.

Salary differentials application form used by F/Z/O status and Adult Education teachers

List of supporting documents required for enrolling dependents in health benefits

For pedagogues and administrative staff. You must provide acceptable certification by a physician or other health care provider for your own serious health condition or the serious health condition of a covered family member within fifteen (15)...

Must be filed along with a FMLA request.

A step-by-step guide for paraprofessionals applying for salary upgrades.

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.

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

Get answers to frequently asked questions about the DOE's Self-Service Online Leave Application System (SOLAS).

A guide to applying for a salary differential on the DOE's salary application system.

A guide to applying for salary steps and differentials on the DOE's salary application system.