The Health Benefits Retiree client service walk-in center is closed. Please resubmit your documents as follows:
1) Forms/documents can 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.
Please do not submit your form/document more than once. This will only delay processing.
You will immediately receive notification stating "Success! Your file has been received" upon completion of your document upload. You will not receive a separate email confirmation.
Please allow 30-45 days from the day you submit your document(s) for them to be processed. Coverage will be retroactive to the effective date of retirement.
2) Forms and documents can be mailed to:
NYC Office of Labor Relations
Health Benefits Program
22 Cortlandt Street, 12th Floor
New York, NY 10007
3) Inquiries and questions can be emailed to firstname.lastname@example.org - do not send forms through email (see #1 and #2 above)
4) For questions regarding the PICA prescription drug benefit program please call 1-800-467-2006.
5) If you are a HIP-HMO member turning 65 or on Medicare due to a disability, please contact HIP at (800) 447-9169 to enroll over the phone. Please identify yourself as a City of New York retiree or dependent of a retiree. For all other members enrolled in a HMO plan, please contact your health plan at the customer service numbers on the back of your ID card.
Please check our website periodically for updates.
Health Benefits Summary Plan Description (SPD)
Retiree Health Benefits Application/Change Form (Not for use by NYCAPS Agencies)
Health Plan Rate Chart for Retirees
Retiree Change of Address Form
COBRA Form, Notice of Rights and COBRA Rates
Young Adult Option Through Age 29 (NYS Law Chapter 240)
Domestic Partner Enrollment Information
Medicare Part B Reimbursement Q&A
Medicare Part B Reimbursement Program Application
2021 Medicare Part B Reimbursement - The reimbursement for the standard Medicare Part B was $1,782.00. Any premiums paid above the standard amount should be submitted using the IRMAA 2021 Application.
2020 Medicare Part B Reimbursement - The reimbursement for the standard Medicare Part B was $1,735.20. Any premiums paid above the standard amount should be submitted using the IRMAA 2020 Application.
IRMAA Medicare Part B Reimbursement
IRMAA Medicare Part B Reimbursement Application (for 2021, 2020, 2019)
IRMAA Medicare Part B Reimbursement Application (2018)
Creditable Coverage Notice (Employees Age 65 or Over)
Form 1054 (For Use By Authorized Personnel Only)
Health Insurance Marketplace (Exchange) Notice