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Forms
Healthcare Related Forms
- Dental Enrollment Form
- 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
- Dental Claim Form
- Dental Plan Information
- Anesthesia Claim Maternity
- Anesthesia Claim Surgical
- Tier III Disability Application
- Surgical Assistance Fund Application
- Life Insurance, Designation of Beneficiary
- Health Care Flexible Spending Account Qualifying Event Change
- Health Care Flexible Spending Account Claim
- Dependent Care Assistance Program Details
- NYC Health Plans
- Change of Address
- Active Beneficiary Enrollment Card
- Attestation of Domestic Partner Status
- Information Regarding NYC Health Benefits for Young Adult Dependents up to Age 29
WTC Forms
- WTC Health Program New Pharmacy Benefit Manager
- WTC Application Addendum
- WTC Health Program - Physical Health Satellite Locations
- WTC Counseling Services
- WTC Notice of Participation
- WTC Health Impacts
- WTC Presumptive Illness Registration Form
- WTC Disability Application for Reclassification
- WTC Disability Application
Employment Forms
Leave Request Forms
HEALTH AND SAFETY Forms
Education Related Forms
IAFF Forms
Compensation Forms
UFA Forms
Military Forms
NYC Fire Pension Forms
- NYC Fire Pension Fund WebEx Seminar 2022 Dates
- Vested Application
- Tier III Vesting Info
- Tier II Vesting Info
- COBRA Package
- Service Retirement Application
- NYC Fire Pension Fund Manual
- NYC Fire Pension Fund WebEx Seminar 2021 Dates
- NYC Fire Pension Fund Telephone Directory
- NYC Fire Pension Fund Electronic Funds Transfer