Claims must be led within  year of the date of service or payment by health plan whichever is later
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Claims must be led within year of the date of service or payment by health plan whichever is later

SHIP Claim Form UFTRTC Supplemental Health Insurance Program SHIP Mail to SHIP PO Box 390 Bowling Green Station New York NY 102740390 Please read reverse side for required documents and bene64257t limitation before submitting claim Incomplete claims

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Claims must be led within year of the date of service or payment by health plan whichever is later




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