Ship claim form 2025

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4 out of 5

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 effective communication.
Input both your Social Security number and the patient's Social Security number along with their birth date in the specified format (Month-Day-Year).
Indicate whether the patient is on Medicare by checking the appropriate box.
Sign and date the form at the bottom. Remember, if you are submitting a claim for a spouse, they must also sign separately.
Select the SHIP Claim Benefit type by entering an amount or placing an 'X' next to the relevant benefit line.
Review all entries for accuracy before submitting. Attach any required documents as outlined on the reverse side of the form.

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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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