Get Health Insurance Enrollment/change Form Active Nyct Nyship Employees (except Sssa, Ms Ii, Tso/twu

This guide provides a clear, step-by-step approach to completing the Health Insurance Enrollment/Change Form for active NYCT NYSHIP employees. It aims to support users in accurately filling out the necessary fields for health insurance enrollment or changes.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling out your personal information in Section 2. Provide your BSC ID, full name, department, contact information, and current address. Ensure that your address is up-to-date to avoid delays in receiving your health insurance cards.
3. Indicate your gender and marital status, along with your date of birth. Be sure to fill in the marital status date if applicable.
4. In Section 3, make your coverage election. Choose between individual or family dental coverage, or opt to waive coverage if you do not wish to enroll.
5. Section 4 requires details about any dependents you wish to enroll or delete. Fill in the necessary information and indicate whether you are adding or deleting a dependent.
6. Refer to Section 5 for required documentation to substantiate dependent enrollment. Ensure all necessary documents are submitted to the Business Service Center within 90 days.
7. Lastly, complete Section 6 by signing and dating the form. This signifies that the information provided is truthful and accurate.
8. Once completed, save your changes. You can download, print, or share the form as needed. Remember to fax a signed copy to 212-852-8700 or email it to bscservice@mtabsc.org.

Ensure your health coverage is in place by completing your enrollment online today.