Retiree Forms
Forms & Resources
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.
Healthcare Related Forms & Resources
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 Programs
Insurance and Claims:
- Beneficiary Enrollment Card - Retirees
- Creditable Coverage Letter 2022
- Domestic Partner Update - 2023
- Elderly Pharmaceutical Insurance Coverage Program (EPIC)
- GHI Urgent Care Participating Providers 2023
- Health Benefits Application for Retired UFA Members
- Life Insurance, Designation of Beneficiary
- Medicare IRMAA Reimbursement Form
- Medicare Part B Reimbursement Form
- NYC Health Plans
- NYC Health Benefits Program Notice of Rate Changes - September 2023
- NYC Health Benefits Program September 2023 Rate Chart - Retirees Only **
- NYC Health Benefits for Young Adult Dependents up to Age 29 Information
- NYC Health Benefits Young Adult Option (Dependents under 29) September 2023 Rate Chart
- Retired Firefighter Security Benefit Fund Summary of Benefits
Optical:
Prescriptions:
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 - MLC Update
- July 7, 2023 Court Ruling
Military Forms
NYC Fire Pension Forms & Info
WTC Related 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 Medical Monitoring
- WTC Notice of Participation
- WTC Presumptive Illness Registration Form
- WTC Workers Compensation
Optical Provider
Active Members can submit a claim once a year. Claims go by Calendar Year. For instance, an Active member can use their optical coverage in August 2016, then again in March 2017.
The UFA allows ACTIVE members to claim up to $130 for optical benefits per calendar year.
The reimbursement rate is as follows:
$30 for exam
$50 for frames
$50 for lenses
or $100 for contact lenses (instead of glasses)