In order to access the forms, you will need the Adobe Acrobat Reader. If you do not already have Adobe Acrobat or the Adobe Acrobat Reader installed, you can download the Reader for free from Adobe by clicking on the icon to the right.

The following forms are available in Adobe PDF format for downloading and printing:

• CSEA Employee Benefit Fund Forms:
  • Claim Form for Physician Co-Pay (up to $125), Prescription Drug Co-Pay (up to $100), Hearing Aid, Maternity
  • Dental Claim Form
  • UCS Legal Services Plan Voucher
  • Vision Care Direct Reimbursement Claim Form - For use with non-participating vision care providers
• Contract Grievance Form
• Non-Contract Grievance Form
• Request for Review of Out-of-Title Work Grievance
• Application for Sick Leave Credits from Sick Leave Bank - Contact your District Administrative Office
• Field Report/Legal Assistance Request
• CSEA Insurance - Address Change Form
• 2008-2009 Partnership For Education and Training (PET) Catalog & Application
• 2008-2009 Partnership For Education and Training (PET) Application
• CSEA Name Change Form

Call 1-877-7-NYSHIP.
Use this toll-free number to reach United Healthcare, Empire Blue Cross and Blue Shield, ValueOptions, Express Scripts, and the Empire Plan Nurseline.

The New York State Health Insurance Program (NYSHIP) web site contains information regarding health benefits and links to health insurance providers and forms. To access their web site, click here: NYSHIP Online.

Information and Claims Instructions