Get Uft C-1259 2013-2025

The UFT C-1259 form is essential for healthcare claims related to dental services for eligible members. This guide provides a clear and supportive approach to help users effectively complete the form online.

Follow the steps to accurately fill out the UFT C-1259 online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred online document editor.
2. Begin by filling out the member information section. Enter your full name, home address, city, state, zip code, and telephone number. If applicable, provide your social security number.
3. Indicate your relationship status by selecting either 'Active Member', 'Retiree', or 'COBRA' as appropriate.
4. In the patient information section, provide the patient’s name and relationship to the member.
5. If the claim is for a spouse or domestic partner, fill in their details, including their name, birthday, and social security number. Indicate whether they have coverage under another dental benefits plan.
6. Provide any required information about additional dental benefits from other companies or organizations.
7. In the authorization section, sign the form authorizing the release of relevant information regarding the claim.
8. For dental service information, complete the Dentist Information section with the dentist's details including name, address, and telephone number.
9. Clearly indicate the services rendered, including the procedure code, and whether x-rays are enclosed.
10. Finally, review all completed sections for accuracy and clarity before saving changes, downloading, printing, or sharing the form.

Complete the UFT C-1259 online to ensure timely processing of your dental claims.