Get Nycemployeebenefits Leapfile Net

This guide provides clear, step-by-step instructions for filling out the Nycemployeebenefits Leapfile Net form online. It is designed for users, regardless of their background knowledge in digital document management, ensuring a smooth and supportive experience.

Follow the steps to successfully complete the online form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Enter your last name, first name, and middle initial in the designated fields.
3. Provide your home address, including apartment number, city, state, and ZIP code.
4. Input your Social Security number and date of birth in the proper format.
5. Indicate the name of the agency you retired from and the name of your welfare fund.
6. Select the health plan you wish to join by placing an ‘X’ in the corresponding box; remember to choose only one plan.
7. For Medicare plans, contact the health plan directly to request a special enrollment form and attach it with your application.
8. Decide if you wish to enroll in the Optional Rider Benefits by marking ‘Yes’ or ‘No’.
9. Sign and date the form to certify that all information provided is accurate.
10. Submit the completed application electronically through the provided link. Ensure all required documents are attached before submission.

Complete your documents online today to ensure your health benefits are updated.