168441-BenefitsEnroll Form - New York University - nyu 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information in the 'Employee Information' section. Include your name, social security number, and NYU phone number.
3. Select your enrollment type by checking either 'I am a new hire' or 'I have a status change'. If applicable, enter the date of your status change.
4. In Section 1, choose your medical coverage plan from the options provided. Indicate whether you want to cover dependents and select the level of coverage desired.
5. Proceed to Section 2 for dental coverage. Similar to medical coverage, indicate if you wish to cover dependents and select the appropriate level of dental coverage.
6. If covering dependents, list their names, relationships, dates of birth, and social security numbers in Section 3. Ensure you attach necessary proof of relationship documents.
7. Complete Sections 4 through 6 regarding Commutation Expense Reimbursement Account participation and Group Life Insurance details as needed.
8. Finally, review all entries for accuracy before signing in Section 7 and submitting your form.

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