Retiree Enrollment Packet

This packet includes several files to help you enroll in the PFT Health & Welfare Funds Programs. Please upload the completed forms to retireeinfo@pfthw.org or UCCI per the instructions on the letter.

• Retiree Benefits Application (Writable)
• Retiree Dental Application (Writable)
• Retiree Dental UCCI EOB
• Retiree Letter - 65 or older January 1 2026
• Retiree Letter - Under 65 January 1 2026
• Retiree NVA Vision EOB
• Retiree Prescription Application (Writable)

PDF • 1.39 MB

PFT Health & Welfare Enrollment Card (PDF)

Fill out this form to enroll in the PFT Health & Welfare Funds Vision, Prescription and Dental benefit programs.

PDF • 164 KB

PFT Basic Vision Form (PDF)

Fill out this form to enroll in the Basic Vision Program.

PDF • 190 KB

Notice of Change (PDF)

Use this form to change your address, or to add or delete a dependent.

PDF • 277 KB

Summary Plan Description (PDF)

Philadelphia Federation of Teachers Health and Welfare and Legal Services Fund Summary of Benefits

PDF • 797 KB

Health Advocate Services Brochure (PDF)

PFT Health & Welfare Fund Health Advocate Services provide personalized support to help you navigate healthcare decisions, understand your benefits, and resolve billing issues.

PDF • 4.3 MB

Medicare & You 2026 Handbook

The official U.S. government Medicare handbook for 2026.

PDF • 4.9 MB

Beyond The Established Norms: A New Kind Of Union Activism (PDF)

Learn about the AFT's approach to union-led professional development.

PDF • 5.4 MB