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
Schedule of Eye Care Benefits
Schedule of Dental Care Benefits
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.