Yonkers federation of teachers welfare fund 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Patient’s Name in the designated field. Ensure that this matches the name on the original paid receipt.
3. In the 'Relationship to Member' section, select from options such as self, spouse, child, or other.
4. Fill in the Name of Member and their Social Security Number accurately.
5. Complete your Home Address, including City, State, and Zip Code.
6. Provide the Patient’s Birthday and Date of Birth in the respective fields.
7. Enter your Home Phone number and Date of Employment in Yonkers System.
8. Answer whether optical benefits are available from any other provider for this patient by selecting YES or NO.
9. If applicable, complete additional information regarding any other vision plans or accidents related to your claim.
10. Check all services performed: Eye Examination, Lenses, Frames as applicable and enter Amount Claimed.
11. Finally, certify that all information is true by signing and dating the form before submission.

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