SHIP Claim FormUFT 2025

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4.4 out of 5

33 votes

The document outlines the claims process for the UFT/RTC Supplemental Health Insurance Program (SHIP), specifying that claims must be filed within one year of service or payment. It details the required claim form, necessary documentation, and limitations for various health benefits, including ambulance services, surgery, dental stipends, and more. The document emphasizes that SHIP is a reimbursement program and provides guidelines on filing claims for different benefits.

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Click ‘Get Form’ to open the SHIP Claim FormUFT in the editor.
Begin by entering your name in the designated field, ensuring you include your last and first name. Next, specify the claim filing year.
Fill in the patient’s name and birth date. If the patient is the member, simply write 'SAME' in the appropriate field.
Provide your address details, including apartment number, city, state, and zip code. Don’t forget to enter your UFT ID number.
Indicate whether the patient is on Medicare by selecting 'Yes' or 'No'.
In the benefits section, mark an 'X' next to each applicable benefit you are claiming. Ensure you understand any limitations associated with each benefit.
Sign and date the form at the bottom. If submitting for a deceased or incapacitated member, contact SHIP directly for guidance.

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Versions	Form popularity	Fillable & printable
2022	4.4 Satisfied (33 Votes)
2012	4 Satisfied (28 Votes)
2010	4.8 Satisfied (26 Votes)

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