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Membership Application (Retired Teachers)

Print and complete the retired teachers’ application only if you are not able to use the online enrollment form.

Payroll Security Access Form

For Access to S locations for Medicaid Claiming

Florida PPO Panel - Dental Schedule

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...

DOE Door Alarm Memo Revised 05-19-21

In accordance with Local Law 36 (also known as "Avonte’s Law"), the NYC Department of Education assessed all school buildings, and where needed, installed door alarms on all exterior doors, with the exception of main entrances.

SHIP direct deposit form

Authorization agreement for SHIP direct deposits

Chancellor's Regulation A-750: Child Abuse Prevention

This regulation covers: procedures for reporting to the New York State Central Register for Child Abuse and Maltreatment, procedures for cooperating with the local Child Protective Services (CPS) investigations of suspected child abuse, legal issues...

Provider/Program Enrollment or Update Request Form

Administration for Children's Services Division of Child Care/Head Start Child Care Support Services; Provider / Program Enrollment or Update Request

Prescription Appliance and/or Medical Equipment Claim Form - HIP Subscribers Only

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.

Professional activities fact sheet (elementary schools)

Contractual guide and list of options for professional activities for elementary school teachers.

Securing School Equipment

The following are proven hints and suggestions that will help to ensure that expensive equipment, including desktop and laptop computers, is kept safe and secure.

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.

Chancellor's Regulation A-449: Safety Transfers

This regulation sets forth the procedures for granting safety transfers (1) when students are victims of a violent criminal offense on school property; and (2) in other situations, when it is determined that a student’s continued presence in the...

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...

Comprehensive Injury Report

This form details the nature of your injuries. It should be turned in to your principal within 24 hours of your accident or illness.

HIPAA: Privacy Practices Statement

Read this notice of privacy practices to understand how protected health information about you may be used and disclosed and how you can get access to this information.