Ship claim form 2025

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28 votes

The document outlines the procedures and requirements for filing claims under the UFT/RTC Supplemental Health Insurance Program (SHIP). Claims must be submitted within one year of service or payment, and a separate claim form is required for each benefit. It details various claim benefits, their limits, necessary documentation, and eligibility criteria, including coordination with other health insurance plans.

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Click ‘Get Form’ to open the SHIP Claim Form in the editor.
Begin by entering your last name and first name in the designated fields. If the claim is for a patient, provide their last and first names as well.
Fill in your address, including apartment number, city, state, and zip code. Ensure that all information is accurate for processing.
Input both your Social Security number and the patient's Social Security number. Also, include the patient's birth date in the specified format (Month-Day-Year).
Indicate whether the patient is on Medicare by checking the appropriate box.
Sign and date at the bottom of the form. Remember that a separate form is required for each different SHIP benefit being claimed.
Select the SHIP Claim Benefit you are applying for by entering an amount or placing an 'X' next to it. Review any specific documentation requirements listed for each benefit.

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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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