Get Ny Enrollment/change Form Medical Spending Conversion (msc) 2020

This guide provides a clear and comprehensive approach to completing the NY Enrollment/Change Form for the Medical Spending Conversion (MSC) program online. It will walk you through each section of the form, ensuring that you have all the necessary information to submit your application successfully.

Follow the steps to complete your online form

1. Press the ‘Get Form’ button to access the online version of the NY Enrollment/Change Form.
2. In Section I, fill in your personal information including your last name, first name, middle initial, social security number, and contact details including your home address, phone numbers, and email address.
3. In Section II, indicate your intention to participate in the MSC Health Benefits Buy-Out Waiver Program. Select whether you wish to enroll or withdraw from the program and provide the necessary details about your non-City group health plan provider.
4. If you are enrolling mid-year, complete Section III with details regarding your Qualifying Event and ensure you provide necessary documentation with the form.
5. Review Section IV and provide your signature to affirm your eligibility and agreement to the terms of enrollment or withdrawal.
6. Finally, save your changes, and choose to download, print, or share your completed form as needed.

Complete your NY Enrollment/Change Form online today for a smooth and efficient experience.