2019 Open Enrollment/Transfer Period Information and Forms

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BENEFIT PLAN	OPEN ENROLLMENT/ TRANSFER PERIOD
Catastrophic Sick Leave Bank Program Catastrophic Sick Leave Bank Program Information Catastrophic Sick Leave Bank Program - Application to Donate Sick Leave Catastrophic Sick Leave Bank Program - Application to Receive Sick Leave Catastrophic Sick Leave Bank Program - Application to Change or Withdraw	Enrollment Period Concluded Oct. 31st
Flexible Spending Accounts Program - FSA Plan Year 2020 - Flexible Spending Accounts Program Brochure Plan Year 2020 - Flexible Spending Accounts Program Application Plan Year 2020 - Frequently Asked Questions Mail to: City of New York Flexible Spending Accounts Program - 2020 Bowling Green Station P.O. Box 707 New York, New York 10274 Note: Retain a copy for your records	Enrollment Period Concluded Nov. 15th
Flexible Spending Accounts Program - Buy-Out Waiver Health Benefits Buy-Out Waiver Program Information Plan Year 2020 - Buy-Out Waiver Program Application Health Insurance Application Note: Current FSA 2019 participants (HCFSA & DeCAP) will receive 2020 re-enrollment packets automatically to the address on file.	Enrollment Period Concluded Nov. 15th
NYC Health Benefits Program 2019 Fall Transfer Period Information - Includes Changes to HIP HMO and EMPIRE HMO Plans Health Insurance Application Health Benefits Program - Dependent Eligibility Required Documentation Health Plans Summary of Benefits and Coverage (SBC) NYC Health Benefits Program Summary Plan Description (SPD) November 2019 and January 2020 Basic Plan and Optional Rider Rate Sheet	Enrollment Period Concluded Nov. 29th
PSC-CUNY Welfare Fund PSC-CUNY Welfare Fund Dental	Enrollment Period Concluded Nov. 29th