Get Uft Welfare Fund's Dental Enrollment/transfer Form 2010

Filling out the UFT Welfare Fund's Dental Enrollment/Transfer Form online is an essential step for individuals seeking to enroll or transfer their dental benefits. This comprehensive guide will walk you through each section of the form, ensuring a smooth completion process.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the plan you choose to enroll in by marking the appropriate checkbox: UFT Welfare Fund Scheduled Benefit Plan, Dentcare (HMO), or UFT Florida Dental Discount Plan (available only for permanent Florida residents).
3. Indicate your membership status by checking one of the options: Employee, Retiree, Pre-70 Retiree, or COBRA.
4. Provide the reason for submission by checking one of the options, such as New hire, Transfer Period, Permanent move in or out of an area, or Retiree. Ensure to fill in the date of the event for permanent moves.
5. Fill in your personal information, which includes your Social Security Number, last name, first name, middle initial, home street address, city, state, zip code, and both home and work phone numbers.
6. Specify your marital status by checking the relevant option: Single, Married, or Widowed/Divorced. Also, provide information about your domestic partner or spouse, including their Social Security Number and whether they are a UFT member.
7. Answer the question regarding coverage by another dental benefits plan, indicating 'Yes' or 'No.' If 'Yes,' specify the name of the other company or organization providing benefits.
8. If you have selected the Dentcare (HMO) plan, fill in the name and code number of the dentist selected from the Directory of Participating Providers. Remember, you can choose a different dentist for each family member, and if only one provider code is entered, all family members will be enrolled in that office.
9. If you have selected the UFT Florida Dental Discount Plan, similarly fill in the name and code number from the Directory of Participating Providers for this plan. Only one dentist may be selected for the entire family.
10. Upon completing the Enrollment/Transfer Form, ensure to sign it. Finally, you may save changes, download, print, or share the form before mailing it to the UFT Welfare Fund at the provided address.

Complete your UFT Welfare Fund's Dental Enrollment/Transfer Form online today to ensure your dental benefits are activated.