UPSEU RETIREE INFORMATION

Dear UPSEU Member,

Congratulations on making the decision to move onto the next amazing phase of your life!

​On this page you will find:

1. All the forms you need to transition to retirement. 
2. A brief VIDEO PRESENTATION about the plans.

​We recommend you view the VIDEO PRESENTATION with the EXPLANATION of PLAN CHOICES  in front of you.

Link will be emailed

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RETIREE “TO DO” CHECKLIST
​Steps to Take to Ensure YOU are Properly Enrolled

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RETIREMENT PLAN CHOICES
EXPLANATION of PLAN CHOICES -  2 types of coverage

• COBRA ENROLLMENT FORM*

​OR

• MTABF PLANS ENROLLMENT FORM*​

View this video to get some quick insight into Benefit Options. Having the Explanation of Plan Choices in front of you is suggested.

*CHANGE OF  STATUS FORM * -  We must have this back & you will use it in the future to update personal information / change of status ie: new address, marry, divorce, etc

DENTAL - ​ (For those who are choosing as part of a plan the following are important forms. Those with a *red star* must be returned with your enrollment papers.)

• DENTAL ENROLLMENT PLAN OPTIONS  - explains how to enroll spouse &/or dependents
• DENTAL ENROLLMENT FORM FOR SPOUSE / DEPENDENTS - use to 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 - (For those who are choosing as part of a plan the following are important forms. Those with a *red star* must be returned with your enrollment papers.)

• LIFE INSURANCE COVERAGE INFORMATION 
• LIFE INSURANCE CHANGE OF BENEFICIARY FORM*
• I HAVE LIFE INSURANCE DECLARATION - put with your w

​VISION  - (For those who are choosing as part of a plan the following are important forms. Those with a *red star* must be returned with your enrollment papers.)

• 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

ADDITIONAL OPTIONAL BENEFITS - (For those who are choosing as part of a plan the following are important forms. Those with a *red star* must be returned with your enrollment papers.)

• 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

1. CHANGE OF  STATUS FORM - update personal info. / change of status ie: new address, marry, divorce, etc
2. VARIABLE BENEFIT FORM​
3. BENEFITS BOOKLET 
4. IMPORTANT CONTACT INFO 

NEW RETIREES 
GIVE FORMS & CHECK to YOUR BUILDING TRUSTEE
or
​MAIL TO:
MTABF
c/o C. JENSEN
39 Grace Lane
Pleasant Valley, NY 12569

BUILDING TRUSTEES EMAIL

• Austin Road  - Tara DelMonaco
• Falls School, Bus Garage, District Office - Jay Melville
• Fulmar Road  -  Lisa Tornambe
• Lakeview  - Kate Legeret​
• Middle School - Andrea D'Aprile
• Middle School -  Kelly Kischak
• High School - Eileen Clements​

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