NEW PALTZ UNITED TEACHERS

BENEFIT TRUST

  • NPUT Benefit Trust

  • PLANS

  • FORMS

  • TRUST BULLETINS

  • PLAN PREMIUMS

  • More

    FORMS

    ​

    Member Registration Form

    ​

    Aflac Cancer Plan Change Form

    ​

    Davis Vision Enrollment Form

    Davis Vision Claim Form

    ​

    Delta Dental Buy Up/Change Form

    Delta Dental Claim Form

    ​

    Domestic Partner Affidavit

    ​

    Long Term Care Enrollment Form  (buy up premiums can be found here)

    ​

    NYSUT Catastrophic Major Medical Change form

    NYSUT Catastrophic Major Medical Claim Form

    NYSUT Catastrophic Major Medical Claim Form Attachment

    NYSUT Catastrophic Major Medical Sample Claim Format

    NYSUT Catastrophic Major Medical Documents Required for Filing Claims 

    NYSUT Catastrophic Major Medical Domestic Partner Affidavit

    ​

    NYSUT Legal Security Package (for writing a will)

    ​

    Personal Representative Form

    ​

    Special Flex Fund Voucher

    ​

    UNUM Life/Long Term Care Buy Up Form

    UNUM Long Term Care Enrollment Kit

    UNUM Short Term Disability Claim Form

    UNUM Long Term Disability Claim Form

    Instructions for completing and filing a Short and Long Term Disability Claim

    UNUM Life/AD&D Change Form

    UNUM Life/AD&D Beneficiary Designation Form

    UNUM Evidence of Insurability Form

    ​

    ​