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EB1054 Health Benefits Report/Inquiry

You should submit this report with your Educational Paraprofessional Leave Application to prevent the disruption of your major medical insurance.

C-25 Application for Reopening of Claim, More than Seven Years After Accident

In order to reopen a claim more than seven years after an accident, this form must be filed immediately with the chair of the Workers' Compensation Board, together with the attending doctor's report ( form C-27 ) if required, at the district office...

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.

Anesthesia Benefit Claim Form - HIP Subscribers Only

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.

Child Care Coverage Request Form

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.

Dental Schedule Florida PPO Panel

For UFT members in the Florida area, this is the Schedule of Benefits. When you use a UFT Welfare Fund participating dentist, you will be provided with the services listed in the Schedule of Covered Dental Expenses without charge except for those few...

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...

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...

Dependent Child Affidavit

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