Active
Forms
Dental Benefits Update
Effective January 1, 2024, UFA Members will receive dental coverage through MetLife
- MetLife Dental Benefits
- MetLife Video for UFA Members
- MetLife Dental Benefits - Effective Jan 2024
- MetLife & UFA
- MetLife December 2023 Update
- MetLife Preferred Dentist Program (PDP)
- Those currently enrolled in the UFA Dental plan will be in the MetLife PDP plan effective 1/1/24.
- PDP FAQS
- Out of Network Claim Form
- MetLife Managed Care Plan (HMO)
- Those currently enrolled in Dentcare will be in the MetLife HMO/Managed Care Plan effective 1/1/24.
- HMO/Managed Care FAQs
- After the January 2024 MetLife rollover, there will be two changeover periods in April and October 2024 for those members wishing to switch plans.
Compensation Forms
Employment Forms
HEALTH AND SAFETY
COVID Testing:
- EmblemHealth City of NY MLC At Home COVID 19 Test Claim Form
- EmblemHealth City of NY MLC At Home Rapid COVID-19 Testing Claim Form Instructions and Info
Health & Safety Forms & Info
- Apparatus Accident Procedures
- CD-73 Narratives
- Company Out of Service Form
- FDNY Radio Codes
- Locker Card for Medical Leave
- "No Gear Beyond This Point!" Poster
- Out-Of-Battalion Detail Form
- Starting Tour Understaffed Form
Health & Safety Programs
IAFF Forms
Leave Request Forms
Medicare Advantage
- Mayor Adams, OLR Commissioner Campion Announce Signing of Medicare Advantage Contract
- Commissioner Campion's Letter to Harry Nespoli (March 30, 2023)
- Statement from Harry Nespoli, Chair of the Municipal Labor Committee (March 30, 2023)
- Aetna Medicare PPO Plan Information for City of New York Retirees
- Aetna Medicare Advantage PPO Common Misconceptions
- Aetna Medicare Advantage Information Session (March 2023)
- Aetna Medicare Advantage Q&A (March 2023)
- Aetna Medicare Advantage Retiree Informational Meeting (presented May 2023 at UFA Seminar)
- Responses to Misconceptions regarding the Aetna Medicare Advantage PPO Plan (June 11, 2023)
- Opt-Out Date Update - MLC Update
Military Forms & Info
NYC Fire Pension Forms
- COBRA Package
- I.T.H.P. Waiver
- NYC Fire Pension Fund Change of Address
- NYC Fire Pension Fund Electronic Funds Transfer
- NYC Fire Pension Fund Manual
- NYC Fire Pension Fund Retirement Checklist
- NYC Fire Pension Fund Telephone Directory
- Service Retirement Application
- Tier III Vesting Info
- Tier II Vesting Info
- Vested Application
Proby Enrollment
UFA Forms
WTC Forms & Info
- WTC Application Addendum
- WTC Disability Application
- WTC Disability Application for Reclassification
- WTC Counseling Services
- WTC Health Impacts
- WTC Health Program - Pharmacy Benefit Manager
- WTC Health Program - Physical Health Satellite Locations
- WTC Health Program - Prescription Plan Fact Sheet
- WTC Notice of Participation
- WTC Presumptive Illness Registration Form
Security Benefit Fund (SBF) Forms & Info
Insurance and Claims:
- (PREVIEW) Active Beneficiary Enrollment Card
- Active Beneficiary Enrollment Card
- Anesthesia Claim Maternity
- Anesthesia Claim Surgical
- Dependent Care Assistance Program Details
- Domestic Partner Update - 2023
- GHI Urgent Care Participating Providers 2023
- Health Benefits Application for Retired UFA Members
- Health Care Flexible Spending Account Claim
- Health Care Flexible Spending Account Qualifying Event Change
- Life Insurance, Designation of Beneficiary
- NYC Health Plans
- NYC OLR Health Benefits Program - Notice of September 2023 Rate Changes & Fall 2023 Transfer Period
- NYC OLR Health Benefits Program: 2023 September Rate Chart - Employees Only **
- NYC OLR Health Benefits Program: 2023 September Rate Chart for COBRA
- NYC OLR Health Benefits Program:2023 September Rate Chart for Young Adult Option (Dependents under 29)
- Surgical Assistance Fund Application
- Surgical Assistance Fund Summary of Benefits
Optical:
Prescriptions:
- FDNY Line-of-Duty (LODI) Prescription Benefit Plan
- What's In Your Wallet? Prescription Card Fact Sheet
SBF Checklists & Additional Forms: