| Send To |
Beneficiary Designation Card |
Campus Benefits Office |
Parental Leave Application |
Chair/unit head for approval and then forward approved leave to the Human Resources Department |
Medicare Part B Reimbursement for TIAA-retirees |
The City University of New York University Benefits Office 395 Hudson Street New York, NY 10014
Email to universitybenefits.retiree@cuny.edu
|
Medicare Part B Reimbursement for TRS Members |
Forms/documents must submitted electronically using the following link: https://nycemployeebenefits.leapfile.net
For detailed instructions on how to submit your form/document securely through LeapFile and to view a short video, click here.
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Medicare Part B IRMAA Surcharge Reimbursement form for:
2019, 2020, 2021
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Forms/documents must submitted electronically using the following link: https://nycemployeebenefits.leapfile.net
For detailed instructions on how to submit your form/document securely through LeapFile and to view a short video, click here.
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Medicare Part B Differential Reimbursement forms:
2018
2019
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Forms/documents must submitted electronically using the following link: https://nycemployeebenefits.leapfile.net
For detailed instructions on how to submit your form/document securely through LeapFile and to view a short video, click here.
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Welfare Fund Adjunct COBRA
Adjunct COBRA, for use as of 7/1/22
|
PSC-CUNY Welfare Fund 61 Broadway, 15th floor New York, NY 10006
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Welfare Fund Full-Time COBRA
Full-Time COBRA, for use as of 7/1/22
|
PSC-CUNY Welfare Fund 61 Broadway, 15th floor New York, NY 10006
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Blue Cross Overseas (International) Hospital Claim Form
|
BlueCard Worldwide Service Center P.O. Box 261630 Miami, FL 33126 USA
or claims@bluecardworldwide.com
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Healthcare Proxy info, form & instructions |
The New York Health Care Proxy Law allows you to appoint someone you trust - for example, a family member or close friend - to make health care decisions for you if you lose the ability to make decisions yourself.
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Delta Dental Disenrollment Form (for switch to Guardian July 1 - July 31, 2022) |
Send to Your Campus Benefits Office
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