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Get Nycaps 2020-2025
How it works
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Open form follow the instructions
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Easily sign the form with your finger
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How to fill out the Nycaps online
This guide provides clear and detailed instructions to assist users in completing the Nycaps health benefits enrollment form online. Whether you are a new hire or an existing employee navigating a qualifying event, this guide aims to simplify the process and ensure you submit an accurate application.
Follow the steps to successfully fill out the Nycaps form.
- Press the ‘Get Form’ button to retrieve the form and open it in the editor.
- Section A: Employee Information. Verify that the information specific to you is accurate. If any details are incorrect, follow the instructions provided to submit a Personal Data Change form for needed corrections.
- Section B: Dependent Information. If you are adding dependents, start by filling out the table with their information. Ensure the first row includes a spouse or domestic partner, followed by dependent children in the next rows.
- For each dependent, indicate whether they will be covered by your health plan in the 'Cover Y/N' field, and enter their full legal names and dates of birth in the respective fields.
- Provide the required documentation based on your dependent status, such as a marriage certificate for a spouse or specific paperwork for children. Make sure you attach copies as required.
- Section C: Dependent Medicare Information. If your dependents have Medicare coverage, fill out this section with the necessary details about their Medicare Part A and B effective dates, legal names, Social Security numbers, and Medicare Claim numbers.
- Section D: Health Benefit Options. Select your desired health plan by writing the appropriate Option Code in the designated area.
- Section E: Employee Certification. Sign and date this section to certify that all provided information is truthful and accurate.
- Section F: Agency Certification. This section will remain blank and is intended for HR Connect benefits representatives to complete.
- After ensuring that all information is correctly filled out, you can save your changes, download, print, or share the completed form as required.
Complete your benefits enrollment online now for a smoother process.
To find your username for NYCaps, refer to the initial registration email sent to you during account setup. If you do not have access to that email, you may contact your HR department for assistance. Alternatively, you might be able to retrieve your username through the NYCaps website if you have forgotten it.
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