2019 Open Enrollment/Transfer Period Information and Forms

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

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

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.

NYC Health Benefits Program

2019 Fall Transfer Period Information - Includes 2019 Changes to HIP HMO and EMPIRE HMO

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)

Health Plan Rates

PSC-CUNY Welfare Fund

PSC-CUNY Welfare Fund Dental