Retirement 2022
UPSEU RETIREE INFORMATION
Dear UPSEU Member,
On this page you will find:
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BUilding Trustees ARE VIA EMAIL![]()
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IMPORTANT FORMS & DOCUMENTS FOR FUTURE USE
*Regardless of which plan you choose, you must mail in the forms with the* next to them.
- RETIREMENT PLANS
- EXPLANATION of PLAN CHOICES - Choose COBRA OR a MTABF PLAN
- *COBRA ENROLLMENT FORM
- *MTABF PLANS ENROLLMENT FORM
- *CHANGE OF STATUS FORM - update personal info. / change of status ie: new address, marry, divorce, etc
- DENTAL (if you are enrolling plan)
- DENTAL ENROLLMENT PLAN OPTIONS - use if enrolling spouse &/or dependents
- DENTAL ENROLLMENT FORM FOR SPOUSE / DEPENDENTS - use if enrolling spouse &/or dependents
- DENTAL CLAIM FORM - Use to get reimbursed for dental expenses
- DENTAL COVERAGE SCHEDULE - amounts covered for dental procedures
- DENTAL PROVIDERS - list of providers who take MTABF dental, but you can use your own
- LIFE INSURANCE (if maintaining your plan)
- VISION (if maintaining your plan)
- *VISION ENROLLMENT - use to allow coverage of spouse &/or dependents
- VISION BENEFIT AUTHORIZATION FORM - use to allow spouse or dependent to use instead of you
- HEARING AID BENEFIT AUTHORIZATION FORM - use to allow spouse or dependent to use instead of you
- FINANCIAL COUNSELING BENEFIT SUMMARY
- LEGAL BENEFIT SUMMARY
IMPORTANT FORMS & DOCUMENTS FOR FUTURE USE
- CHANGE OF STATUS FORM - update personal info. / change of status ie: new address, marry, divorce, etc
- VARIABLE BENEFIT FORM
- MAJOR MEDICAL REIMBURSEMENT
- BENEFITS BOOKLET
- IMPORTANT CONTACT INFO
*Regardless of which plan you choose, you must mail in the forms with the* next to them.
PLEASE DO NOT MAIL FORMS TO PREFERRED.
GIVE FORMS to YOUR BUILDING TRUSTEE or MAIL ALL FORMS TO:
MTABF
c/o C. JENSEN
39 Grace Lane
Pleasant Valley, NY 12569
GIVE FORMS to YOUR BUILDING TRUSTEE or MAIL ALL FORMS TO:
MTABF
c/o C. JENSEN
39 Grace Lane
Pleasant Valley, NY 12569