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Excess Medical, Prescription Drug &
​Dental forms for
ACTIVE GNTA MEMBERS

GNTA In-Service Extra Medical
File Size: 140 kb
File Type: pdf
Download File

GNTA RX Form
File Size: 90 kb
File Type: pdf
Download File

COVID at-HOme test reimbursement

UHC At-Home COVID Test
File Size: 79 kb
File Type: pdf
Download File

NYS AFFiRMATION OF ISOLATION

NYS Affirmation of Isolation
File Size: 109 kb
File Type: pdf
Download File

2022 Summer Scholarship

2022
File Size: 214 kb
File Type: pdf
Download File



DENTAL FORMS FOR ACTIVE GNTA MEMBERS AND RETIREE Benefit trust members

Please not that the new Dental Form is the same form to be used by all in-service & retiree BTF members!
NEW: GNTA Dental Form
File Size: 758 kb
File Type: pdf
Download File

NEW: GNTA Participating Dental Providers
File Size: 308 kb
File Type: pdf
Download File

GNTA Dental Fee Schedule 2020
File Size: 187 kb
File Type: pdf
Download File


Excess Medical & Prescription Drug Forms for RETIREES/PARAPROFESSIONALS

GNTA Retire/Para Prescription Drug Form
File Size: 230 kb
File Type: pdf
Download File

GNTA Retiree/Para Excess Medical Form
File Size: 258 kb
File Type: pdf
Download File

Notice of Change to Benefit Plan
File Size: 46 kb
File Type: pdf
Download File


EXPENSE REPORT WITH UPDATED MILEAGE RATES FOR 2022

2022 Expense Report
File Size: 105 kb
File Type: pdf
Download File


HEALTHCARE PROXIES FOR COLLEGE STUDENTS

If you have a child who is eighteen years of age or older and a college student, you can now have a healthcare proxy and HIPAA authorization prepared for them under the comprehensive legal services program of the Great Neck Teachers Association Benefit (“Fund”).
 
            College students who are eighteen years of age or older are legally adults under the Federal Health Insurance Portability and Accountability Act (“HIPAA”), and therefore, medical officials at college health centers and other facilities may not speak with the student’s parents about the student’s medical condition.
 
            This can be addressed by the child/adult/student executing a healthcare proxy designating the parent as an agent or proxy entitled to receive information about the child’s medical condition and discuss treatment options and a supplemental HIPAA authorization. The parent can also gain access to the child’s medical records, and most importantly, make treatment decisions on behalf of the child/adult/student.
 
            Once the child/adult/student has executed these documents, copies should be provided to the college health center to keep on file.
 
            If you wish to have a healthcare proxy and HIPAA authorization prepared for your child/adult/student naming you his/her proxy, please contact the Fund office to make an appointment with an attorney from the panel law firm.


Mirkin and gordon
power of attorney chaNGes

Great Neck Teachers Association
NYSUT, AFT-NEA, AFL-CIO #2686 | The Cottage • 343 Lakeville Road • Great Neck, NY 11020 
gnteachers@gmail.com | @GNTeachers
(516) 829-9070