2019 Open Enrollment/Transfer Period Information and Forms

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