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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.
  • SHIP claims MUST be filed within 1 year of the date of service or payment by health plan(s), whichever is later. If a claim is returned to you by the SHIP office for additional information, you will have the later of 1 year from the date of service or payment by the health plan(s) or 90 days from the date of the SHIP letter to provide that information or the claim will be denied.
  • Required supporting documents are listed on the back of the SHIP claim form, including, but not limited to the Explanation of Benefits (EOB) statements from health plan(s) and proof of payment for claim submitted. Please be sure to include them. Incomplete claims will be returned.
  • You MUST sign, date and complete a separate SHIP Claim Form for each claim.
  • SHIP does not provide benefits other than those specifically listed in this 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:

52 Broadway, 17th floor
New York, NY 10004




Fax: 212-514-8427



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