Benefit Forms & Information
- AETNA Summary of Benefits and Coverage
- AETNA Medicare Advantage Plan Benefit Summary
- AETNA Enrollment/Change
- AETNA Medical Claim Form
- AETNA Medicare Medical Claim Reimbursement Form and Instructions
- Prescription Drug Claim Form
- Annual Certification of Spouse and Dependent Eligibility (online)
- Annual Certification of Spouse and Dependent Eligibility (form)
- Spousal and Dependent Eligibility Rule
- Spousal and Dependent Eligibility Rule Flow Chart
- Spousal and Dependent Certification Flow Chart
- Certification of Dependent Child
- Certification of Marriage
- Health Benefit "Buy In" Agreement
- CSEA Dental Claim
- CSEA Vision Claim Form
- Mail Order Pharmacy Information and Order Form
- Direct Reimbursement Claim
- Domestic Partner Policy
- LETF 2022 Information Packet
- LETF Dental Fund Information Sheet For Active Teachers
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- LETF Dental Fund Information Sheet For Retirees
- LETF Raymond Opticians Vision Benefits
- LETF Student Dependent Certification
- LETF Unum Beneficiary Designation Form
- LFT NYSUT Membership Form For Retirees
- Department of Labor New Health Insurance Marketplace Coverage Options
- Medicare Members Prescription Drug Coverage & Medicare Information
- Putnam/Northern Westchester Health Benefits Consortium Plan Document
- Open Enrollment for District Medical Insurance Plan & AETNA Enrollment/Change