How to file a SHIP claim form

Download the SHIP claim form

How to file a claim:

• Before you or your covered spouse/domestic partner file a claim with SHIP, you or your covered spouse/domestic partner MUST have been paid or denied benefits by all other health plan(s) for which you maintain coverage.
• A completed, payable SHIP claim form MUST be filed within 1 year of the date of service or payment by health plan(s), whichever is later. Dental, Emergency Alert System, Prescription Drugs & Surgical Stockings/Sleeves benefits have exceptions, they must be filed by December 31st of the subsequent year. 
• SHIP will make every effort to inform a member they submitted a claim less than the benefit maximum. However, it is the member’s responsibility to be aware of SHIP’s rules and limitations. 
• Required supporting documents are listed on the back of the SHIP claim form. SHIP is a reimbursement program so all claims MUST include proof of payment such as copy of front and back of cancelled check, copy of scanned check from bank statement or copy of credit card receipt/statement. If a claim is returned to you by the SHIP office due to incorrect filing, you will have the latter of 1 year from the date of service or payment by health plan(s) to resubmit the claim. If you have received a letter requesting additional information, you will have 90 days from the date of the SHIP letter or filing deadline, whichever comes first, to provide additional information or your claim will be denied. 
• Sign, date and complete a separate SHIP claim form with required documents for each member and each benefit claimed.
• SHIP does not provide benefits other than those specifically listed in our benefits booklet or published in the New York Teacher.

Note: Your Social Security number is your identification for all claims, inquiries and enrollment. SHIP does not issue membership cards. SHIP payments are made to the member, regardless of who is the claimant. SHIP is a reimbursement program; all claims must be paid prior to submission. SHIP does NOT accept assignments from providers.

Payment of claims on behalf of a deceased member

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 surviving class of the following classes of successive preference beneficiaries:

The deceased member’s

• widow/widower or surviving domestic partner
• surviving children
• estate.

Submit your completed form and necessary documentation via:

If you need help when filing your claim, call 212-331-6314.