Nypd Health Insurance Form

1 inquiries and questions can be emailed to healthbenefits olr nyc gov.

Nypd health insurance form. Please resubmit your documents as follows. 125 broad st 11th flr new york ny 10004 2400 phone. Sections a b c. Changing health insurance dependents to change the dependents on health insurance by mail or in person please contact the nypd health insurance section 51 chambers street 3rd floor new york new york 10007 or call 646 610 5122 for information.

The health benefits retiree client service walk in center is closed. Form 1095 c is distributed to all full time employees working an average of 30 hours or more per week for all or part of the calendar year. The health benefits retiree client service walk in center is closed. 212 437 9480 site use agreement.

Nypd health insurance section 280 broadway 212 374 7654. I understand that i have an option to decline this benefit by obtaining a medical spending conversion form both of which are obtainable at my payroll office. 718 760 7600 24 hour operation pba funds office. Due to the closure of the office if you mailed or faxed forms or correspondence march 11 2020 or after we cannot access or process that form.

We have listed a series of forms below that will among other things make it easier for members to file grievances challenge unlawful employment actions of the department assert rights under the health and safety laws and challenge evaluations. Form 1095 c is a tax form under the affordable care act aca which contains information about your health care insurance coverage. All forms directed to the department must be typed. 125 broad st 11th flr new york ny 10004 2400 phone.

212 437 9480 site use agreement. Furthermore i agree that my periodic health plan deductions if any will be made on a pre tax basis pursuant to the internal revenue code 125. 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. Due to the closure of the office if you mailed or faxed forms or correspondence march 11 2020 or after we cannot access or process that form.

Changing deferred compensation plan beneficiaries. Section 125 does not apply to retirees. 1 inquiries and questions can be emailed to healthbenefits olr nyc gov.