Prescription Card Breakdown

SBF Contact Information

UFA Members:
Click Here to Search for Participating UFA Optical Providers

UFA Optical Providers Can Log in by Clicking HERE

NYC Health Plans Site
The Official NYC Health Plans Site

UFA Retirees Information
UFANYC.org Retiree Area

Dental Providers - Find a Dentist
Healthplex

Health Care Providers - Find a Doctor
UFA Catastrophic Major Medical Insurance Plan & Benefits
Aetna U.S. Healthcare
CIGNA HealthCare
Empire Blue Cross Blue Shield
GHI
HIP Health Plans
Health Net
Vytra Health Plans

Forms
Click form title to download PDF document

NYC Forms

• Change of Employee Address for LODI
• Deferred Compensation Plan Forms
• Dependent Care Assistance Program Claims
• Health Benefits Application
• Health Care Flexible Spending Account Claims
• Health Care Flexible Spending Account Qualifying Event Mid-Year Change
• Medical Spending Conversion Enrollment Change
• WTC NYS Workers Comp Retired FDNY Volunteers
• Military Repayment Plan Enrollees Prior to 12/07/2006. Form: DP-2541
• Military Repayment Plan Enrollees After 12/07/2006 Form: DP-2542

FDNY Forms

• FDNY Change of Address
• 50% Indicator
• Bereavement Leave Request
• Direct Deposit
• Emergency Leave Request
• Extra-Departmental Employment Request (EDE)
• Grievance Presentation
• I.T.H.P. Waiver
• Jury Duty Notification
• Life Insurance Fund of New York Fire Dept. Beneficiary Designation
• Military Leave Request
• Return to Duty from Vacation Leave Interrupted by Medical Leave
• Self Mutual Request
• Special Vacation Request
• Surgical Assistance Fund Application
• Vacation Leave Interrupted by Medical Leave
• WTC Disability Application for Active Members
• WTC Disability Application for Retired Members

• WTC Disability Application for Reclassification
• WTC Presumptive Illness Registration Form

UFA Forms

• UFA Change of Address/Phone/Email Form
• Company OOS Chart List
• Company Out of Service Fax Form
• Coordination of Benefits Form
• Firehouse Closed Fax
• Healthplex Dental Form
• Anesthesia Claim Surgical
• Anesthesia Claim Maternity
• FirePAC
• Locker Card for Medical Leave
• Retirement & 20 Year Certificate Request
• UFA Event Volunteer List