Benefits Information

Health Insurance Marketplace Notice

Declination of Health and/or Dental/Vision Benefits

HIP 2017 Summary of Benefits

Ameritas

Announcement Letter

Dental Claim Form

Vision Claim Form

The Empire Plan

The Empire Summary of Benefits and Coverage is available at https://www.cs.ny.gov/sbc/pa/index.cfm.

If you do not have internet access, call 1-877-769-7447 and select Option 1 for the Medical Program to request a copy.

Access to search for participating providers

Health Claim Form


Life Insurance

Designation of Beneficiary