Welfare Fund Benefits | Send To |
Temporary CVS/Caremark Rx Drug Card |
Delta Dental Claim Form |
Delta Dental of NY, Inc. PO Box 2105 Mechanicsburg, PA 17055 |
Guardian (non-participating) Dental Reimbursement Claim Form |
Group Dental Claims P.O. Box 981572 El Paso. Texas 79998-1572
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Dental Reimbursement Form (Retiree Plan 70) |
PSC-CUNY Welfare Fund 61 Broadway, 15th Floor New York, NY 10006 |
Dental Reimbursement Form (Retiree Plan 80) |
PSC-CUNY Welfare Fund 61 Broadway, 15th Floor New York, NY 10006 |
Vision Benefit Reimbursement Form (Your Member ID# is your Social Security# unless you have specifically asked Davis to change it to another number.)
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Vision Care Processing Unit P.O. Box 1525 Latham, NY 12110
tel: 800-283-9374 fax: 888-328-4761
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CVS/Caremark Prescription Drug Claim Form |
CVS Caremark PO Box 52136 Phoenix, AZ 85072-2136 |
SilverScript Med D Prescription Drug Claim Form |
CVS Caremark PO Box 52066 Phoenix, AZ 85072-2066 |
Prescription Drug Exemption Request Form |
PSC-CUNY Welfare Fund 61 Broadway, 15th floor New York, NY 10001 |
Prescription Drug Reimbursement Form (Retiree Plan 70) |
PSC-CUNY Welfare Fund 61 Broadway, 15th Floor New York, NY10006 |
Extended Medical Benefit Claim Form |
Administrative Services Only, Inc Department # 178 P.O. Box 9009 Lynbrook, NY 11563-9009 |
Hearing Aid Reimbursement |
For out-of-network claims first contact HearUSA at 1-800-442-8231 prior to your appointment to be eligible for a maximum $500 direct reimbursement. |
High-Cost Rx Program Reimbursement Claim Form |
Administrative Services Only, Inc P.O. Box 9009, Department # 178 Lynbrook, NY 11563-9009 1-877-362-2869 |
Optional Benefits | Send To |
Catastrophe Major Medical Insurance Claim Form |
The United States Life Insurance Company P.O. Box 1868 London, KY 40743 Email: emm_claims@aig.com
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