Get City Of New York Office Of Labor Relations Health Benefits Program - Qcc Cuny
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How to fill out the City Of New York Office Of Labor Relations Health Benefits Program - Qcc Cuny online
This guide provides step-by-step instructions on how to fill out the City of New York Office of Labor Relations Health Benefits Program - Qcc Cuny form online. Designed for young adults seeking to continue health benefits coverage, this guide ensures users can navigate the form easily and effectively.
Follow the steps to successfully complete the Health Benefits Program application.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out the subscriber information section. Indicate whether you are an employee or retiree by selecting the appropriate checkbox. Provide the last name, first name, middle initial, address, social security number, home telephone number, apartment, city, state, zip code, and the name of the city agency you are employed by or retired from.
- Next, complete the young adult information section. Include the young adult's last name, first name, middle initial, address, social security number, apartment, date of birth, city, state, zip code, and their relationship to the subscriber.
- Select the health plan in which the young adult is enrolling by checking the corresponding box. It is important to note that the young adult must elect the same health plan as the subscriber. Indicate whether you wish to opt for any optional benefits by checking 'Yes' or 'No'.
- In the acknowledgment of premium payment obligation section, the young adult must certify their eligibility by signing the form and printing their name. Indicate the effective date of the coverage.
- The subscriber must also sign and print their name in the designated area, ensuring the date is completed.
- After completing all sections of the form, ensure to keep a copy for your records before mailing the signed form to the appropriate health plan address listed in the document.
- Finally, save any changes made, download a copy of the filled form, print it if necessary, or share the form as needed.
Complete your enrollment in the Health Benefits Program online today!
You can contact the NYC retirement system by visiting their official website or calling their customer service number. The City Of New York Office Of Labor Relations Health Benefits Program - Qcc Cuny is part of this system, and they can assist you with inquiries related to your retirement benefits. It's beneficial to gather your retirement information beforehand so that representatives can provide timely and accurate assistance. You can also explore helpful resources on their site to help answer your questions.
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