Get Nycaps Central

This guide provides detailed steps on how to complete the Nycaps Central enrollment/change form for the Medical Spending Conversion program. Following these instructions will help ensure that your form is completed accurately and efficiently.

Follow the steps to complete your enrollment/change form.

1. Press the ‘Get Form’ button to retrieve the Nycaps Central form and open it for editing.
2. Begin by filling out the Employee (Participant) Information section. Provide your last name, first name, middle initial, social security number, home address, phone numbers, email, and agency name.
3. In the MSC Health Benefits Buy-Out Waiver Program section, choose whether you wish to enroll or withdraw from the Buy-Out Waiver Program by selecting the appropriate option. Check the corresponding box for individual, domestic partner, or family coverage, as applicable.
4. If applicable, complete the Mid-Year Qualifying Event section by certifying the event that affects your benefits, providing the necessary documentation, and noting the dates of the qualifying event and the current date.
5. Sign and date the form in the Employee Signature section, confirming that you have read the program materials and meet the qualifications to enroll or withdraw.
6. Make sure that your agency’s Human Resources Department completes Section V, including their signature and effective dates.
7. After filling in all necessary fields and sections, save the changes, and proceed to download, print, or share the completed form as required.

Complete your Nycaps Central documents online to ensure your enrollment is processed smoothly.