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Get For Retirees And Vestees Of New York State Government And Their Enrolled Dependents Special Option
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How to fill out the For Retirees And Vestees Of New York State Government And Their Enrolled Dependents Special Option online
Filling out the For Retirees and Vestees of New York State Government and their Enrolled Dependents Special Option form online is essential for ensuring you have the right health coverage. This guide will help you navigate the form step-by-step, providing clarity on each section and instruction.
Follow the steps to successfully complete your form.
- Click the ‘Get Form’ button to access the form online.
- Provide your personal details, starting with your name and Social Security number. Ensure all information is accurate to avoid delays.
- Fill out your address, including city, state, and ZIP code. If you are moving, indicate whether it is a new address and provide the date of the new address.
- Indicate if you or any dependents are enrolled in Medicare by selecting 'Yes' or 'No.' If applicable, enter the effective dates for Medicare Part A and B.
- Specify your current health insurance option by providing the option code and plan name. Then, select your desired new option code and plan name if you are changing.
- Sign and date the form. Include signatures for any dependents enrolled in Medicare, along with their respective information.
- Once completed, submit the form to the Employee Benefits Division by the specified deadline, ensuring it is sent to the correct address.
- You can save, download, print, or share the form as needed after filling it out.
Start filling out your documents online today to ensure your health coverage is up to date.
If you retired from a New York State agency and enrolled in a health insurance plan through the New York State Health Insurance Program (NYSHIP), you are reimbursed for the usual cost of the Medicare Part B (medical insurance) premium through your retirement benefit, unless you receive reimbursement from another source ...
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