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Optional Rider Claim Forms

Optional Rider Claim Form - NYC Health Insurance Plans

This form is for retired members who have elected a New York City optional rider or New York City health plan, or are covered under their spouse’s/domestic partner’s NYC health plan.

Optional Rider Claim Form - Non-NYC Health Insurance Plans

This form is for retired members who have elected a non-New York City optional rider for health insurance or prescription plan, or are covered under their spouse’s/domestic partner’s non-NYC health plan.