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  • Tiers 3, 4, 5 & 6 Loan Application (for Members Covered By Articles 14, 15 Or 22) - Rs5025-a

Get Tiers 3, 4, 5 & 6 Loan Application (for Members Covered By Articles 14, 15 Or 22) - Rs5025-a

Tiers 3, 4, 5 & 6 Loan Application (For Members Covered by Articles 14, 15 or 22) RS 5025-A (Rev. 6/16) O ffice of the New York State Comptroller.

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How to fill out the Tiers 3, 4, 5 & 6 Loan Application (For Members Covered By Articles 14, 15 Or 22) - RS5025-A online

Filling out the Tiers 3, 4, 5 & 6 Loan Application can seem daunting, but this guide will help you navigate each section with confidence. By following the steps outlined below, you will ensure that your application is completed accurately and efficiently.

Follow the steps to complete your loan application online.

  1. Press the ‘Get Form’ button to access the application form and open it for editing.
  2. In the Personal Information section, provide your Social Security Number, Registration Number (if known), last name, first name, middle initial, and your permanent mailing address including the unit or apartment number, city, state, and zip code. Also, include your home phone and work/cell phone numbers.
  3. Complete the Required Information section by indicating whether you have any outstanding loan balances with your current employer through other retirement plans. If you have loans from multiple employers, total them for this section.
  4. In the Loan Type section, select only one loan type based on your current situation: whether you have existing loans with the retirement system, are requesting a new loan, or refinanced loans.
  5. For the Loan Amount section, select the amount you wish to borrow, being mindful of the tax implications of your choice. Additionally, indicate your desired loan repayment amount per pay period.
  6. Fill out the Payroll Information section, providing your employer's name, annual salary, payroll frequency, and your employment term.
  7. Sign the document in ink and ensure that it is notarized. Without a signature and notary, your application will be rejected.
  8. Finally, save your changes, print a copy for your records, and prepare to submit the form by mailing it to the address provided in the application.

Complete your loan application online today to take the next step towards your financial goals.

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What does each drug tier mean? Drug TierWhat it meansTier 3Preferred brand. These are brand name drugs that don't have a generic equivalent. They're the lowest-cost brand name drugs on the drug list.Tier 4Nonpreferred drug. These are higher-priced brand name and generic drugs not in a preferred tier.3 more rows • 9 Jan 2023

Tier 3. The prescription drug tier which consists of higher-cost prescription drugs, most are brand-name prescription drugs, and some are specialty drugs. Tier 4. The prescription drug tier which consists of the highest-cost prescription drugs, most are specialty drugs.

Level or Tier 1: Low-cost generic and brand-name drugs. Level or Tier 2: Higher-cost generic and brand-name drugs. Level or Tier 3: High-cost, mostly brand-name drugs that may have generic or brand-name alternatives in Levels 1 or 2. Level or Tier 4: Highest-cost, mostly brand-name drugs.

Tier 5 - Nonpreferred Specialty: In Tier 5 are nonpreferred specialty drugs that likely have a more cost-effective generic or preferred alternative available. Tier 5 has the highest copayment for specialty drugs. In some cases, they may not be covered.

Tier 3—Non-preferred, brand-name prescription drugs. Higher copayment. Specialty tier—Very high cost prescription drugs. Highest copayment or coinsurance.

Tier 5 - Nonpreferred Specialty: In Tier 5 are nonpreferred specialty drugs that likely have a more cost-effective generic or preferred alternative available. Tier 5 has the highest copayment for specialty drugs. In some cases, they may not be covered.

Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs. Tier 4: Highest cost prescription drugs.

Tier 4 medications are non-preferred specialty medications. Tier 4 medications will have the highest member cost share. For Members who have a 3-tier benefit plan structure, medications within this PDL denoted as tier 4 medications will assess the 3rd tier Member cost share.

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Get Tiers 3, 4, 5 & 6 Loan Application (For Members Covered By Articles 14, 15 Or 22) - RS5025-A
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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232