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Forms and claims

For forms needing validation, such as optical and hearing aid, members should access the Forms Hotline at 212-539-0539. Current panel listings and some forms are also available online.

Fund representatives are available to members who request assistance with specific health plan related problems. Members should include in any correspondence their full name, address, Welfare Fund alternate ID number or social security number, and telephone number. Members should always include photocopies of appropriate documentation such as the Health Benefits Application or the claim rejection notice from the health plan and a Protected Health Information Authorization Form (PHI) giving the Health Plan permission to discuss your claims.

Note: Health Insurance claim forms are available directly from the carrier and are not supplied through the Fund.

Submission of Claims Rules

Dental Claims (Direct Reimbursement)*

These claims must be submitted to CIGNA within one (1) year from the date of service. The penalty for late submissions will be non-payment of the claim.

Hearing Aid Claims

These claims must be submitted to the UFT Welfare Fund no later than ninety (90) days from the date of service. The penalty for late submissions will be non-payment of the claim.

Optical Claims (Direct Reimbursement)*

These claims must be submitted to the UFT Welfare Fund no later than ninety (90) days from the date of service. The penalty for late submissions will be non-payment of the claim.

Optional Rider Reimbursement Benefit

You must notify the Fund in writing within two (2) years from the date the benefit should have been paid.

Medicare Part D Catastrophic Reimbursement Form

Due to legal requirements this form must be submitted by Feb. 1 of the year following the calendar year requested.

Generally speaking, no exceptions will be granted for the late submissions of claims. However, physical inability to file within the period e.g., because of hospitalization or like circumstances, will be given consideration. Likewise, there will be no penalties for delays which are beyond the member's control, such as by a primary carrier or arbitrator. In these cases, appropriate documentation will be required. The late filing of a claim by a dentist, doctor or other provider will not be considered an exception, since it is the member’s responsibility to file claims.

Claim forms must be fully completed, giving all requested information or the claim cannot be processed. Claims which have been rejected and returned to the member for additional information must be resubmitted within ninety (90) days of the date of rejection, or by the original submission deadline, whichever is later. If claims are ultimately rejected by the Fund Office, you may appeal the rejection. You must do so by writing the Board of Trustees within sixty (60) days of the rejection.

With respect to any claims incurred prior to a member’s death, benefits will be made payable, in the absence of a named beneficiary(ies), to the first surviving class of the following classes of successive preference beneficiaries:

The deceased member’s:

  1. widow/widower or domestic partner;
  2. surviving children;
  3. estate.

*Direct reimbursement means that a member has not utilized the services of a panel provider. When using the services of a participating provider (panelist), the panelist will submit the claim.

Third-party reimbursement/subrogation

If a covered member or dependent is injured through the acts or omissions of a third party, the Fund shall be entitled -- to the extent it pays out benefits -- to reimbursement from the covered member or dependent from any recovery obtained from the responsible third party. Fund benefits will be provided only on the condition that the covered member or dependent agrees in writing:

To reimburse the Fund, to the extent of benefits paid by it, out of any monies recovered from such third party, whether by judgment, settlement or otherwise; and

To take all reasonable steps to effect recovery from the responsible third party and to do nothing after the injury to prejudice the Fund's right to reimbursement.

Overpayment/future offset

In the event you receive an overpayment of Welfare Fund benefits, on your behalf or on behalf of your dependent, you are obligated to refund this overpayment to the Fund immediately. In the event you fail to refund this overpayment, the Fund can offset this overpayment against future benefits until this overpayment is fully recouped, or suspend your benefits until this overpayment is paid in full. Such offset and/or suspension can be applied to the member’s and eligible dependents’ benefits.