Benefit Trust Fund

Enrollment Form

Complete this form if you have changed your name or address. If you change your name due to marriage, please attach a copy of your marriage license.

Dependent Student Semester Verification Form

Complete this form, each semester, for your dependent post-secondary student.

Proposed Orthodontic Treatment

Have your orthodontist complete this form before any treatment has begun.

Clarification Of Orthodontic Treatment

Have your orthodontist complete this form once banding is complete.

Dental Benefits Claim

Complete this form to claim dental benefits

Board of Trustees

Board of Trustees of the Newburgh Teachers’ Association Benefit Trust Fund

NTA BTF Premium Schedule

Retired teachers must join the NTA retiree chapter and pay $50 dues to be eligible for Trust Fund Benefits. Retired Teaching Assistants must join the NTA retiree chapter as “social members” and pay $25 dues

Non-Participating Provider Vision Claim Form

Out of Network vision provider form for reimbursement