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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.
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In order to cover a domestic partner on your City health benefits coverage, you must have a Domestic Partnership Registration Certificate issued by the Office of the City Clerk and complete a Health Benefits Application (if you are already registered as domestic partners through another municipality or governmental
Once you begin teaching full-time, you can enroll as a union member with the UFT. As a UFT-represented employee, you will be entitled to premium-free health insurance and an array of UFT Welfare Fund-administered supplemental health benefits that include prescription drugs, dental care, optical coverage, and more.
Obtain a domestic partner instruction sheet from your personnel office or the Office of Labor Relations if you wish to include a domestic partner on your medical coverage. If you are adding or dropping a dependent or changing plans, this form should be submitted within 31 days of the qualifying event.
Obtain a domestic partner instruction sheet from your personnel office or the Office of Labor Relations if you wish to include a domestic partner on your medical coverage. If you are adding or dropping a dependent or changing plans, this form should be submitted within 31 days of the qualifying event.
It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.
Optional Riders All health plans, except DC 37 Med-Team have an Optional Rider consisting of benefits that are not part of the basic plan. You may elect Optional Rider coverage when you enroll and pay for it through payroll deductions. Each rider is a package and you may not select individual benefits from the rider.
If You Need Assistance Contact your agency health benefits or payroll office or NYCAPS Central at (212) 487-0500. Department of Education employees should contact HR Connect at (718) 935-4000: For questions concerning eligibility and enrollment.
Changes In Family Status - Adding/Dropping Dependents Employees should report all changes in family status to their agency health benefits or payroll office or NYCAPS Central at (212) 487-0500 (Department of Education employees should contact HR Connect at (718) 935-4000) within 30 days after the event.