Health benefits application nyc

    • [PDF File]Applicant MUST check one: EMPLOYEE Health Benefi ts ...

      https://info.5y1.org/health-benefits-application-nyc_1_4f397c.html

      Applicant MUST check one: EMPLOYEE Health Benefi ts Application City of New York RETIREE Health Benefi ts Program REASON(S) FOR SUBMISSION (Check one or more boxes: enter change …

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    • [PDF File]City of New York Health Benefits Program Frequently Asked ...

      https://info.5y1.org/health-benefits-application-nyc_1_cde03e.html

      City of New York Health Benefits Program Frequently Asked Questions for Retirees UPON YOUR RETIREMENT YOU WILL BE ENROLLED FOR HEALTH BENEFITS ON THE FIRST DAY OF YOUR …

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    • [PDF File]2020 ENROLLMENT/CHANGE FORM Employee (Participant) return ...

      https://info.5y1.org/health-benefits-application-nyc_1_e99948.html

      1) For the Health Benefits Buy-Out Waiver Program (Section II), I have reviewed and processed the Health Benefits Application and certify that the employee has listed a non-City group health insurance …

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    • [PDF File]Instructions for completing a Health Benefits Application ...

      https://info.5y1.org/health-benefits-application-nyc_1_d73000.html

      Instructions for completing a Health Benefits Application (For Employees) (Please print all information clearly using a black or blue ballpoint pen) Check the EMPLOYEE box at the top of the form. Sections …

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    • [PDF File]Health Benefits Application Health Benefits Program

      https://info.5y1.org/health-benefits-application-nyc_1_222c13.html

      H. TO PARTICIPATE IN THE HEALTH BENEFITS PROGRAM - PLEASE SIGN AND DATE BELOW (Participant must sign either Section H or I) I certify that the above information is correct and I …

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    • [PDF File]Health Benefits Program Employees For ... - New York City

      https://info.5y1.org/health-benefits-application-nyc_1_38b2b7.html

      I certify that the above employee/retiree is eligible for the New York City Health Benefits Program (HBP) and that dependent documentation has been verified in accordance with HBP procedures. I certify that …

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