STD form - NYSNA Pension Plan and Benefits Fund - rnbenefits 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Part A, ‘Claimant’s Statement.’ Fill in your full name, Social Security number, address, and contact information accurately. Ensure all dates are correct.
  3. Indicate the date you became disabled and provide details about your disability. If applicable, list any employers you worked for in the eight weeks prior to your disability.
  4. In Part B, bring the form to your doctor for completion. They will need to provide their diagnosis and treatment details.
  5. Next, take the form to your employer for Part C. They will confirm your employment details and any compensation received during your disability period.
  6. Once all parts are completed, ensure you sign the form before mailing it to the Benefits Fund within 20 days of becoming disabled.

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A pension plan is an employee benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides retirement income or defers income until termination of covered employment or beyond.
If you need help locating your pension, you can contact The Pension Action Center using their online request form or toll-free at 1-888-425-6067.
Established in 1972 and located in Albany, NY, the New York State Nurses Association Pension Plan and Benefits Fund are separate, multiemployer plans providing health insurance and retirement benefits for RNs and other medical professionals throughout New York State represented under collective bargaining by NYSNA.
Is a nonprofit organization formed to provide NYSNA members and participating employers an affordable, comprehensive, and efficient plan of health insurance.
We are NYSNAthe New York State Nurses Association. With over 42,000 members, NYSNA gives frontline nurses and healthcare professionals a unified voice to promote the health and welfare of our members, our profession, and the people of New York state.

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