• Declination of Health and/or Dental/Vision Benefits

• Employee Accident and Injury Report

• Mandatory Proofs for all Insurance Enrollments

• New Health Insurance Marketplace Coverage Options and Your Health Coverage
  

Ameritas

• Schedule of Eye Care Benefits

• Schedule of Dental Care Benefits

• Announcement Letter

• Dental Claim Form

• Vision Claim Form

• Enrollment Form Ameritas

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.