Download Forms


SelectionFile type iconFile nameDescriptionSizeRevisionTimeUser
ċ

View
Survivor Support In conjunction with your Life Insurance, there is a Survivor Support Program, to which you and/or your beneficiary are entitled. There are two scenarios to this program: 1.If the member dies, the beneficiary receives the survivor benefit. 2.If the member’s spouse dies, the member will receive the survivor benefit. The Program includes the following benefits: One-on-one financial counseling. You can schedule a meeting with a Survivor Support counselor to help identify objectives and priorities. These counselors are selected for their financial planning expertise as well as their sensitivity to, and knowledge of, survivor issues such as: •Do I need to do anything with the will? •Do I have enough money to maintain my current standard of living? •What are the tax implications of my decisions? •How much social security am I eligible for, and for how long? •What other factors should I consider now that I’m alone? A personal financial plan: The counselor will be available by phone for continued assistance for six months after the initial meeting. This access will help develop and implement the strategies needed to help protect resources, preserve current lifestyles and build future security. If you would like additional informational information, please contact one of your Trustees or call the toll-free number listed here.  Feb 13, 2014, 8:16 AM CTABTF Admin
Ċ
View Download
  42k v. 1 Sep 15, 2014, 6:11 PM Sue Lewis
ċ

View
  Sep 17, 2017, 6:27 PM Sue Lewis
Ċ
View Download
Assist America/ Worldwide Emergency Travel Services Authorization for Release of Medical InformationFormThis can can help you care for your adult child (over 18) if they are traveling more than 100 miles from home within the US or abroad and need assistance. If your child is under 18 and needs medical treatment, the minor's private medical information must be provided to the parent. But at 18, when the child becomes an adult, the Health Insurance Portability and Accountability Act of 1996 (HIPAA Law) requires that Assist America/ Worldwide Emergency Travel Services keep private medical information acquired from or about the adult child. The parent does not have an independent right to be informed by Assist America/ Worldwide Emergency Travel Services. Before they leave for their trip, the adult child must sign and submit this authorization form to Assist America/ Worldwide Emergency Travel Services permitting the sharing of private health information with the parent. Send form to: Assist America/ Worldwide Emergency Travel Services, Inc. 202 Carnegie Center, Suite 302 B Princeton, NJ 08540  54k v. 1 Jan 21, 2014, 6:04 AM CTABTF Admin
Ċ
View Download
Change to Member Status  76k v. 1 Jan 21, 2014, 6:01 AM CTABTF Admin
Ċ
View Download
Catastrophic Major Medical Plan Book  1285k v. 1 Jan 21, 2014, 5:58 AM CTABTF Admin
Ċ
View Download
Catastrophic Major Medical Claim Form  48k v. 1 Jan 21, 2014, 5:59 AM CTABTF Admin
Ċ
View Download
HIPAA Authorization  72k v. 1 Jan 21, 2014, 5:59 AM CTABTF Admin
Ċ
View Download
Critical Illness Claim Form   125k v. 1 Jan 21, 2014, 6:02 AM CTABTF Admin
Ċ
View Download
Group Life Insurance Plan Booklet  116k v. 1 Jan 21, 2014, 6:08 AM CTABTF Admin
Ċ
View Download
CTA BTF Plan Book  229k v. 1 Feb 13, 2014, 8:14 AM CTABTF Admin
Ċ
View Download
Dental Claim Form  93k v. 1 Jan 21, 2014, 6:00 AM CTABTF Admin
ċ

View
  May 10, 2017, 7:23 AM Sue Lewis
ċ

View
Health Advocate helps members solve problems and find solutions related to healthcare and health insurance needs. The cost for this benefit is paid for by the Trust. Our Health Advocate service just got even easier to use with a new Web site personalized for CTA members! Print your id card, download an authorization form, view a quick reference guide and so much more!  Jan 21, 2014, 6:06 AM CTABTF Admin
Ċ
View Download
While Assist America/ Worldwide Emergency Travel Services is only available for active members (not retirees), there are a two other travel assistance benefits that are available to both actives and retirees: 1. The first program, available through NYSUT, covers us for Accidental Death & Dismemberment ("AD&D") 24 hours a day, 365 days a year, while traveling on business or pleasure. For Common Carrier-related losses, Insured Persons are covered while in, entering or exiting a Common Carrier or a Conveyance operated by a military transport service as an emergency replacement for a Common Carrier. The maximum AD&D benefit amount for Business & Pleasure is $1,500 and for Common Carrier is $3,000. Click on the link to the left for a scanned copy of the brochure. 2. The second program which is also free to us is called Chubb Travel Assist. This program puts you in touch with a network of providers that can address the medical and legal needs of travelers. So, if you or a covered family member traveling with you become seriously ill, need a prescription refilled, require a legal referral, or lose your passport when traveling, Chubb Travel Assist can assist you. And to help ensure that you are well prepared before your trip, the program also provides access to essential information such as required immunizations. Chubb Travel Assist is a travel-related assistance service that focuses on providing coordination services to sick or injured travelers, including: Medical Assistance Services: . Worldwide Medical and Dental Referrals . Monitoring of Treatment . Facilitation of Hospital Payments . Transfer of Insurance Information to Medical Providers . Medication, Vaccine and Blood Transfers . Dispatch of Doctors and Specialists . Transfer of Medical Records . Continuous Updates to Family, Employer and Home Physician . Hotel Arrangements for Convalescence . Replacement Corrective Lenses and Medical Devices Travel Assistance Services: . Replacement of Lost or Stolen Travel Documents . Emergency Travel Arrangements . Transfer of Funds . Legal Referrals . Translation Services . Message Transmittals To receive a brochure on the Chubb Travel Assist program please give NYSUT a call at (800) 626-8101 and request that a hard copy be mailed to you.  133k v. 1 Feb 13, 2014, 6:55 AM CTABTF Admin
Ċ
View Download
Life Insurance and Long Term Care Insurance Portability Coverage Forms  79k v. 1 Feb 13, 2014, 8:08 AM CTABTF Admin
Ċ
View Download
Life Insurance and Long Term Care Insurance Portability Coverage Forms  59k v. 1 Feb 13, 2014, 8:08 AM CTABTF Admin
ċ

View
  Oct 14, 2014, 10:24 AM Sue Lewis
Ċ
View
  Oct 8, 2014, 12:41 PM Sue Lewis
ċ

View
  Sep 28, 2015, 5:37 PM Sue Lewis
Ċ
View Download
Assist America/ Worldwide Emergency Travel Services can help you if you are traveling more than 100 miles from home within the US or abroad and need assistance.   379k v. 1 Feb 13, 2014, 6:24 AM CTABTF Admin
Ċ
View Download
Assist America/ Worldwide Emergency Travel Services can help you if you are traveling more than 100 miles from home within the US or abroad and need assistance.   186k v. 1 Feb 13, 2014, 6:24 AM CTABTF Admin
Ċ
View Download
Assist America/ Worldwide Emergency Travel Services can help you if you are traveling more than 100 miles from home within the US or abroad and need assistance.  273k v. 1 Feb 13, 2014, 6:26 AM CTABTF Admin
ċ

View
Good News! When you have questions, concern or emotional issues surrounding your personal or work life, you can now get support through UNUM’s Employee Assistance Program (EAP). Keeping your work and personal life in balance can sometime be tricky. Stressful situations can affect your health, well-being and ability to focus on what’s important. That’s when you can pick up the phone and speak confidentially to a master’s level consultant who can help you or a family member. Call: 1-800-854-1446 or click: www.lifebalance.net Please refer to your member card for your user id and password, or contact a BTF trustee.  Feb 13, 2014, 8:12 AM CTABTF Admin
ċ

View
If you have a long term care policy or are interested in finding out more about long term care insurance you may want to visit UNUM’s new Website customized for CTA members. Remember that currently the Trust pays the first $100 toward the premium for active teachers each year. *Please note the link to UNUM is not an endorsement, but is for information purposes only. Applicants should apply due diligence in evaluating the policy before enrolling.  Feb 13, 2014, 8:11 AM CTABTF Admin
Ċ
View Download
Vision Claim Form  148k v. 1 Jan 21, 2014, 6:00 AM CTABTF Admin
Ċ
View Download
Assist America/ Worldwide Emergency Travel Services can help you care for your adult child (over 18) if they are traveling more than 100 miles from home within the US or abroad and need assistance. If your child is under 18 and needs medical treatment, the minor's private medical information must be provided to the parent. But at 18, when the child becomes an adult, the Health Insurance Portability and Accountability Act of 1996 (HIPAA Law) requires that Assist America/ Worldwide Emergency Travel Services keep private medical information acquired from or about the adult child. The parent does not have an independent right to be informed by Assist America/ Worldwide Emergency Travel Services. Before they leave for their trip, the adult child must sign and submit this authorization form to Assist America/ Worldwide Emergency Travel Services permitting the sharing of private health information with the parent. Send form to: Assist America/ Worldwide Emergency Travel Services, Inc. 202 Carnegie Center, Suite 302 B Princeton, NJ 08540  54k v. 1 Feb 13, 2014, 6:30 AM CTABTF Admin