2021 Open Enrollment/Transfer Period Information and Forms

BENEFIT PLAN
OPEN ENROLLMENT/
TRANSFER PERIOD
Flexible Spending Accounts Program - FSA

Plan Year 2022 - Flexible Spending Accounts Program Brochure

Plan Year 2022 - Flexible Spending Accounts Program Application

Frequently Asked Questions

Note: Current FSA 2021 participants (HCFSA & DeCAP) will receive 2022 re-enrollment packets automatically to the address on file.

Important Notice- FSA Program
The Flexible Spending Accounts Program client service walk-in center remains closed to visitors.

IMPORTANT: Please read about Program changes due to COVID-19
Please submit your forms and documents as follows:
1) Inquiries and questions can be sent via email to the Program.
2) Forms and documents can be submitted electronically to: https://nyc-fsa.leapfile.net

Please do not submit your form/document more than once.  This will only delay processing.  You will immediately receive notification stating "Success! Your file has been   received" upon completion of your document upload.  You will not receive a separate email confirmation.

•    Also, please do not send forms or documents via express mail.
•    Please check back periodically for updates and how to send forms and claims electronically to the Program.

IMPORTANT - If you are currently receiving your reimbursement via check, please complete a Direct Deposit Form in order to receive reimbursement in a timely fashion.  Do not mail your completed form to the address on the form. Please submit your completed form following the directions above.
Download Adobe Scan to convert your hardcopy documents into PDFs. Use your smart phone or tablet camera to take a picture of your paper form and Adobe Scan will convert it to a PDF. Adobe Scan mobile app is available for iPhone and Android.
    
How to Submit Files – Instructions and Video

      October 12th - November 19th 
Flexible Spending Accounts Program - Buy-Out Waiver

Health Benefits Buy-Out Waiver Program Information

Plan Year 2022 - Buy-Out Waiver Program Application

Health Insurance Application

      October 12th - November 19th
NYC Health Benefits Program

2021 Fall Transfer Period Information 

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)

July 2021 Basic Plan and Optional Rider Rate Sheet

        November 1st - November 30th  
PSC-CUNY Welfare Fund

PSC-CUNY Welfare Fund Dental 

        November 1st - November 30th 
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

        November 1st - November 30th
Dedicated Sick Leave Program

Dedicated Sick Leave Program Policy and Applications

         November 1st - November 30th

 

Last Updated: 10/13/2021 20:35