Instructions for completing a Health Benefits Application - NYC gov - nyc 2025

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The document provides detailed instructions for completing a Health Benefits Application for both employees and retirees of the City of New York. It outlines the necessary steps, sections to fill out, and required documentation for various scenarios such as new enrollments, adding or dropping dependents, and changes in health plans. Specific guidelines are given for both active employees and retirees, including information on health plans available, eligibility criteria, and submission procedures.
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NYC Health Benefits Program All current health plans remain in effect. No retiree will be moved into the new Medicare Advantage PPO Plan. No opt-out requests made through Aetna via their call center or website will be processed at this time.
You can docHub NY State of Health by calling us toll free at 1-855-355-5777 (TTY: 1-800-662-1220). If you have questions about health plans, financial assistance, or anything else about NY State of Health please contact our Customer Service Representatives at 1-855-355-5777.
Log into your NY State of Health account at nystateofhealth.ny.gov. Meet with an enrollment assistor to receive assistance with updating your account. Call the NY State of Health Customer Service Center at 1-855-355-5777.

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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.
The MSC Health Benefits Buy-Out Waiver Program allows eligible employees who can obtain non-City group health benefits to waive their New York City health benefits in return for an annual cash incentive payment.
The Health Benefits Retiree Client Service Center is open for in-person meetings on Wednesdays only, by appointment only. It remains closed to walk-in visitors. To make an appointment to meet with a Client Service Representative call (212) 513-0470.
To enroll, you must obtain and file a Health Benefits Application at your payroll or personnel office or NYCAPS Central.

Related links

NEW YORK STATE MEDICAID PROGRAM MIDWIFE

A copy of the form and instructions for completion are included in the Billing. Guidelines section of this Manual. To obtain the DSS-3134 Form, in English

Learn more
employee-health-benefits-application.pdf

Centralized NYCAPS agency/H+H employees MUST complete the Health Benefits Application through their employee self service. Non-Centralized agency employees

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