If you are in an employee benefits eligible position:
You can enroll, make changes or additions if you are newly hired or have a life changing event. Documentation will be required for a life changing event.
Enrollment can be done each year during our open enrollment period from October 1st through October 31st for a January 1st effective date..
Click to open
Empire NYSHIP enrollment form
LTD_Enrollment_form_METLIFE_eff_JULY_2019.pdf
MetLife LTD enrollment form
LTD_Enrollment_form_METLIFE_Admin_eff_JULY_2019.pdf
MetLife LTD Admin enrollment
Prudential Life ins enrollment
Prudential Life-Admin-enroll
Prudential_Life_Ins_beneficiary_pages_only.pdf
Life beneficiary change form
DISABILITY_STATUS_REQUEST_FORM.pdf
Emblem Disabled Dependent form
CSEA EBF enrollment form
CSEA_MEMBERSHIP_APPLICATION.pdf
CSEA Union Membership form
CSEA_DUES_PAYROLL_DEDUCTION_AUTHORIZATION.docx
CSEA DUES authorization form
Solstice_NY_ENROLLMENT_NEW_VISION_Form_(Fillable)8.2023.pdf
SOLSTICE-SPECTERA VISION ENROLLMENT FORM 2023
EMBLEM HEALTH ENROLLMENT FORM
MetLife_HMO_Dental_Enrollment_Form.pdf
METLIFE DENTAL DHMO ENROLLMENT FORM 2023
MetLife_PPO_Enrollment_Form_05910063__Deer_Park_2023.pdf
METLIFE DENTAL PPO ENROLLMENT FORM 2023