FORMS NEEDED FOR ENROLLMENT:

1. ​MTABF Enrollment & Change of Life Form ***
   
2. Dental Enrollment Announcement 
3. Dental Enrollment ***
4. Dental Claim Form ​
5. Dental Providers 
6. Vision Enrollment ***
7. Vision Benefit Assignment Authorization Form
8. Hearing Aid Benefit Assignment Authorization Form
9. Life Coverage Info Letter 
10. Life Insurance Enrollment & Change of Beneficiary ***
11. I Have Life Insurance  ​
12. Financial Counseling Summary
13. Legal Overview Information ​
14. Claim Form (only if enrolling dependents in dental)  *** ​
15. Major Medical Reimbursement 
16. Important Contacts Info 
17. Benefits Booklet 

 *** These forms & documentation must be returned via inter-office mail to Charles Jensen at the Middle School or mail  to:
MTABF
P.O. Box # 656
Baldwin Place, NY 10505 

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Mahopac Teachers Association Benefit Fund
P.O. Box # 656
Baldwin Place, NY 10505
​Phone: 845.543.7415

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