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Forms and claims

How to Obtain Forms, Current Panel Listings and Information

For forms needing Fund validation such as optical and hearing aid, members should call the Forms Hotline at 212-539-0539.

UFT Chapter Leaders have panelist listings, dental forms and other Welfare Fund literature.

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. In any correspondence members should include 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

Disability Claims (DBL1) Your first claim (DBL1- Initial application) must be filed no later than thirty (30) days following your waiting period or thirty days (30) following the issuance of your Leave, whichever is later. Failure to file within this period may result in the loss of benefits for the period between the 29th day of disability (the 15th day for Non-Pedagogues and Paraprofessionals) and the date the claim is received by the Fund Office. Physical inability, or delays in obtaining the required documentation necessary to file within this period, may be considered an exception and will be given consideration.

Disability Claims (DBL2) You should submit your DBL-2 Supplemental Application no later than thirty (30) days following the last date of the previous UFT Welfare Fund Disability Payment.

Prescription Drug Claims (Direct Reimbursement)* These claims must be submitted to the UFT Welfare Fund no later than ninety (90) days from the date the drug is dispensed. The penalty for late submissions will be nonpayment of the claim.

Dental Claims (Direct Reimbursement)* These claims must be submitted to CIGNA within one 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.

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 that 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 from the date of rejection, or by the original submission deadline, whichever is later. If the Fund Office ultimately rejects claims, you may appeal the rejection. Appeals must be in writing and sent to: Board of Trustees UFT Welfare Fund, 52 Broadway, 7th fl , New York, NY 10004, 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 child(ren);
  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;

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 the overpayment against future benefits until the overpayment is fully recouped, or suspend your benefits until the said overpayment is paid in full. Such offset and/or suspension can be applied to the member’s and eligible dependents’ benefits.