(845) 563-3400     124 Grand Street, Newburgh, NY 12550
 

Health Benefits



Latest News from Health Benefits Dept.

NEW Vesting Requirement for Tier 5 and Tier 6 ERS Memberships

Are You Vested?
Being vested means that you have earned enough service credit to qualify for a pension benefit once you meet the minimum age requirements established by your retirement plan. Vesting is automatic; you do not have to fill out any paperwork to become vested.

Tier 1, 2, 3 or 4 members who have at least five years of credited service are vested.

As of April 9, 2022, Tier 5 and 6 members also only need five years of service credit to be vested. This newly enacted vesting requirement change affects members of both the Employees’ Retirement System (ERS) and the Police and Fire Retirement System (PFRS). Previously, Tier 5 and 6 members needed ten years of service to be eligible for a service retirement benefit.

Effective immediately, if you are a Tier 5 or 6 member with five or more years of service and you meet the minimum age requirements for your retirement plan, you can apply for a service retirement benefit if you wish. If you have between five and ten years of service credit and you have questions about filing for retirement, please contact us.

Tier 5 and 6 members who left public employment with five or more years of service and did not withdraw their membership are now considered to be vested.

Tier 5 and 6 members who leave public employment with more than five years of service but less than ten years, as of April 9, 2022, now have the option to either apply for a retirement benefit once you reach retirement age or withdraw your contributions. You cannot withdraw your contributions once you have ten years of service. As a reminder, once you withdraw your contributions, you end your membership with NYSLRS and are no longer eligible for a retirement benefit.

The new legislation does not change eligibility for disability retirement benefits that are established by your retirement plan. This legislation also did not change Tier 6 benefit rules such as how long you must contribute, your pension benefit calculation, your full retirement age, reductions to retire early or the cost to purchase previous service.

If you were a Tier 5 or 6 member and have been off the payroll for more than seven years prior to April 9, 2022, your membership is considered withdrawn and terminated. You would need to return to payroll and reinstate your withdrawn membership in order to be eligible for five-year vesting.

Covid Test Kit Reimbursement Information

Effective January 15, 2022 for MVP HMO and PPO enrollees members can submit to the insurance plan for reimbursement for up to 8 covid tests per month:
Commercial, self-funded, and Essential Plan members can submit requests for reimbursement using the Claim Reimbursement Request Form, or the CVS Caremark Prescription Reimbursement Claim Form. Members will need to attach receipts with the specific test noted and UPC codes from the test box.  For more information on OTC at-home test reimbursement, member’s can contact the MVP Customer Care Center at the phone number on the back of their MVP Member ID card.  Please download  and complete the claim form and return it to MVP at the address provided on the form. Please be sure to attach the receipt as specified with the test detail and upc codes from the test box.

Effective January 15, 2022, under direction from the federal government, the Empire Plan will cover FDA-authorized at-home COVID-19 Over the Counter (OTC) diagnostic tests.  A doctor’s order or prescription is not needed. Members should go to the pharmacy counter with the COVID-19 test(s) so that the tests can be processed and covered through your insurance.

All enrollees and dependents are eligible for this benefit. OTC diagnostic tests are covered with no out-of-pocket cost at participating network pharmacies using your Empire Plan, Excelsior, or SEHP ID Card. If you are charged for a test at a participating network pharmacy, submit for reimbursement through Caremark.com or through the paper claim process.  If you need assistance, call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 4 for the Empire Plan Prescription Drug Program, 24 hours a day, 7 days a week. 

Coverage includes up to eight (8) at-home COVID-19 tests, per covered member, per month. Tests are covered at no cost or are fully-reimbursed at participating network pharmacies. If you purchase a test outside of a participating network pharmacy (such as Amazon), the maximum allowable reimbursement is $12 per test ($24 for a box that contains two tests). Save your receipts to submit for reimbursement.  

As of January 18, 2022, the list of OTC FDA-authorized tests* are:
BinaxNOW COVID-19 Antigen Self Test
COVID-19 At-Home Test (SD Biosensor, Inc.)
CLINITEST Rapid COVID-19 Antigen Self-Test
iHealth COVID-19 Antigen Rapid Test
CareStart COVID-19 Antigen Home Test
BD Veritor At-Home COVID-19 Test
SCoV-2 Ag Detect Rapid Self-Test
InteliSwab COVID-19 Rapid Test
Celltrion DiaTrust COVID-19 Ag Home Test
QuickVue At-Home OTC COVID-19 Test
Flowflex COVID-19 Antigen Home Test
Ellume COVID-19 Home Test

*The list of FDA-authorized tests is subject to change.

Claims / Receipt Submission Information

If you are charged for a test at a participating network pharmacy, submit for reimbursement through Caremark.com or through the paper claim process

If a test is paid for out-of-pocket at a non-participating network pharmacy (e.g., Amazon or other online retailer), then Empire Plan members can submit for the maximum reimbursement through UnitedHealthcare (UHC) online at www.myuhc.com.  There will be information about OTC test reimbursement highlighted in a banner at the top of the website.

Plan members can also mail or fax a claim form to UHC, using the OTC At-home COVID-19 Test Kit Reimbursement Form which will be available on www.myuhc.com beginning January 15, 2022. The claim form and proof of payment must be mailed to UnitedHealthcare P.O. Box 1600, Kingston, NY 12402-1600 or faxed to (845) 336-7716.
Questions

If you have any questions, please call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program. Representatives for the Medical Program (UHC) are available Monday-Friday, from 8:00a.m. to 4:30p.m., ET.  Representatives for the Prescription Drug Program (CVS Caremark) are available 24 hours a day, 7 days a week. 

Emblem Health Covid-19 Test Reimbursement

Please see our enclosed Q&As with regard to COVID 19 testing and instructions for reimbursement of FDA approved in-home testing kits.  Please note that at this time, members will need to submit a reimbursement form, along with itemized receipts to have their claims reviewed for reimbursement.  

We will pass along additional information as it is made available to us. 

Please note the following: 

  • In the future, EmblemHealth is working on a program where you can purchase a covered COVID-19 at-home, rapid test at an in-network pharmacy with zero out-of-pocket cost by presenting your member ID card at the time of purchase.
  • In the meantime, when members pay out-of-pocket for tests at a retail store, online, or a pharmacy, they will  have to send in some information to be reimbursed for each test. This includes a completedclaim form  and the itemized receipt. (EmblemHealth may require an attestation that this test is for the member only, and not for a non-covered purposes, as part of the claim process.)
  • For more specific details, go to COVID-19 testing on emblemhealth.comor connecticare.com.  There members can learn how to find a participating in-network pharmacy, or get instructions about how to fill out the claim form. Members may also call the phone number on their member ID card and speak with a representative who will help.  

For your convenience, I have included here a copy of the reimbursement claim form, as well as copy of our current Q&As on testing from our www.emblemhealth.com which can be found under our COVID 19 section.  The first attachment provides instructions on how to complete the form. 

If members do have any questions, as per above, we encourage them to contact the member services number on the back of their ID cards for further assistance.  I also attached a copy of the claim form for download.

Coverage of At-Home COVID-19 Test Kits

Please be advised that effective January 15, 2022, and due to a directive from the federal government, CDPHP is covering at-home COVID-19 test kits that are FDA-approved or issued an EUA by the FDA.

At this time, for all commercial members (including self-funded), we will be reimbursing for kits purchased out of pocket (up to $12 per test or $24 for a kit containing two tests).

The test kits will be covered under a group’s pharmacy benefit. For groups that carve out their pharmacy benefits, any questions should be directed to their PBM.

Members may obtain up to eight tests (or four kits containing two tests) per covered family member, per calendar month. For example, if the first test kit is purchased on January 15, a maximum of eight tests can be purchased by February 14.

To avoid an upfront cost, members will need to purchase the test kit at a pharmacy window or pharmacy counter of a pharmacy in the CDPHP network.

If members choose to purchase a test kit at a non-participating pharmacy or other retailer, there would be an upfront cost with reimbursement; reimbursement will require this form.

This directive currently does not include Medicare Advantage (MA) members. CDPHP will alert MA members as soon as we have updated guidance and direction from the government.

At this time, MA members who purchase test kits with a provider order can receive reimbursement as a medical claim by submitting both the script and their receipt either via paper claim or in their online member account.

Please note that effective January 19, 2022, all Americans will be able to order free rapid coronavirus tests online at COVIDtests.gov.

Additional detail is forthcoming, and we will be issuing updated guidance as often as it is received. We thank you for your cooperation.

January 2022 EAP Newsletter
Here is January 2022 EAP Newsletter

 

NYS Department of Civil Service will be issuing new NYSHIP cards:  Please read below:
Effective January 1, 2022, a new federal law requires the inclusion of annual out-of-pocket costs on employee health insurance benefit cards and this requirement impacts all NYSHIP plans. Empire Plan Benefit Cards Beginning on Monday, November 15, 2021, new Empire Plan benefit cards will be issued for all enrollees and covered dependents.  Enrollees can begin using the new benefit cards immediately and securely shred or destroy all other cards. Enrollees do not need to activate this card or place a call to the Department or the Empire Plan administrators prior to use. What is Different: The new benefit cards will include annual deductible and out-of-pocket maximum information based on the enrollee’s Benefit Program. To accommodate differences in these amounts, there will be two versions of the cards (Individual and Family).The cards have also been redesigned to incorporate Plan and administrator logos, the group number and bin number as well as the Department of Civil Service website. What is not Changing: Information included with the new card advises enrollees that the nine-digit identification number (“AltID”) is not changing and that health benefits are not changing. The card will continue to list The Empire Plan toll-free number and other important information to aid with claims submissions.

 

Health Insurance Open Enrollment

Our annual open enrollment period for Medical will begin on Friday Oct 1, 2021 through Tuesday, November 30, 2021 with changes effective Jan 1, 2022.  All employees eligible for either district insurance or the health insurance buy-out must complete the open enrollment for medical. 

For those who have district insurance:  You must log into INAVIGATOR and enroll in a benefit plan for the upcoming plan year.  Even if you are not making any changes, you must complete the medical open enrollment.  If you are adding dependents you must also send me the following documents: If adding a spouse: marriage certificate and copies of birth certificate and social security card.  If adding children: copies of birth certificates and social security cards.

For those employees who take the buy-out: You must log into INAVIGATOR and decline the medical coverage.  You do not need to upload your Medical ID card again if you already participate in the health insurance buy-out.

 

2021-2022 Health Insurance Buy-Out - Posted May 3, 2021

Our annual Health Insurance Buy-Out open enrollment period will run from May 3, 2021- June 18, 2021. Open enrollment notification for the Health Insurance Buy-Out and Reminder emails will go out during the months of May and June.  If you are interested in enrolling in the Health Insurance Buy-Out for the 21-22 school year, then please be sure to log into our INAVIGATOR benefit portal and enroll during this time. If you are not interested in the 21-22 Health Insurance Buy-Out, then please disregard the email notifications and reminders. 

Once you enroll in the medical buy-out through INAVIGATOR, the system will generate a required task on your INAVIGATOR home page. The required task of uploading a copy of your current health insurance ID card, must be completed in order to process your Health Insurance Buy-Out for the first October 2021 payroll.  If you do not complete the enrollment by the deadline, then you will not receive the Buy-Out payment with the first October 2021 pay.

 

April Newsletter- Posted April 6, 2020 

Read this month's EAP Newsletter

February Newsletter- Posted February 5, 2020 

Read this month's EAP Newsletter

November Newsletter - Posted November 13, 2020 

Read this month's EAP Newsletter

Open Enrollment - Posted October 1, 2020 

Our annual open enrollment period for Medical will begin on Friday Oct 2, 2020 through Monday, November 30, 2020 with changes effective Jan 1, 2021.  All employees eligible for either district insurance or the health insurance buy-out must complete the open enrollment for medical. 
For those who have district insurance:  You must log into INAVIGATOR and enroll in a benefit plan for the upcoming plan year.  Even if you are not making any changes, you must complete the medical open enrollment.  If you are adding dependents you must also send me the following documents: If adding a spouse: marriage certificate and copies of birth certificate and social security card.  If adding children: copies of birth certificates and social security cards.
For those employees who take the buy-out: You must log into INAVIGATOR and decline the medical coverage.  You do not need to upload your Medical ID card again if you already participate in the health insurance buy-out.

 

 

Important Information concerning the 20-21 Flex Plan Open Enrollment - August 21, 2020

Please note that the 2020-2021 Flex Plan/Aflac Open Enrolment will run from Monday, August 30, 2020- Wednesday, September 16, 2020.  Our new Flex plan year begins on October 1, 2020.  The new FSA annual allowable amount for this plan year is $2750.00. The DCA deduction remains at $5000.00 max per household. Deductions for the Flex plan are pre-taxed, with payroll contributions made over the course of 19 pay periods during the school year.  The first deduction will begin on 10/9/2020.  An email will be forthcoming regarding the open enrollment for the Flex/Aflac plans.  No enrollments will be accepted after September 16th, 2020, so please plan accordingly.

Health Insurance Buyout - May 19, 2020

Our annual Health Insurance Buy-Out open enrollment period runs from May 1, 2020- June 19, 2020.  If you are interested in the Health Insurance Buy-Out, please be sure to enroll in the Health Insurance Buy-Out for the 20-21 school year through the district's benefit portal, INAVIGATOR. In order for your buy-out to get processed, you must enroll and upload a copy of your current health insurance ID card to the portal by the June 19th, 2020 deadline.

NYSLRS Member Statements - May 19, 2020

When will I receive my Member Annual Statement?

Statements are scheduled to be distributed in late spring. It’s important to make sure NYSLRS has your correct email and mailing address. Sign in to your Retirement Online account and update your contact information if needed. You can also receive your annual statement faster by choosing to receive it by email. You’ll receive an email that directs you to Retirement Online to see your statement when it’s ready. If you don’t choose email delivery, we will mail your statement to your home.

How do I get a copy of my Member Annual Statement?

Starting this year, you will be able to sign in to Retirement Online to view and print your statement.

You can also request a reprint by:

We can’t reprint:

  • Statements from previous years.
  • Reprints of the current year from March 31 until the mailing for that year is complete (generally in June).

Remember, your statement provides information as of the end of the State fiscal year (March 31). Your Retirement Online account displays more recent information, and it is updated regularly after your employer reports your service and earnings to NYSLRS. If you need account information for a financial institution (for example, if you are applying for a mortgage), please read the Mortgage Letter/Account Verification section of this FAQ.

For more information members can visit https://www.osc.state.ny.us/retire

 

COVID-19 INFORMATION 

Telemedicine Services

Here's some additional information about Covid-19 and virtual doctor visits. This is an important information from MVP. Here's also a direct link to MVP's myERvisit.

Additional Information

Some weeks ago, we created the Covid-19 resource center on the ESI member website, www.theEAP.com/Educators-EAP. We continue to update that resource center with new information every few days so login to see what’s new.

Plus, we have just added 5 new video trainings to help you and your employees deal with the Covid-19 epidemic. We have included a video to help educate employees on the virus. And for those who have employees working remotely, there are videos to help those employees and their managers.

You can access the resource center and the new videos by logging on to the ESI website www.theEAP.com/Educators-EAP. Links to each of the training videos can be found in the Coronavirus (COVID-19) Resource & Training Center after you’ve logged in to the site. Click here for instructions to access the EAP Self-help resources.

The following is a brief summary of the training videos.

Preparing for an Epidemic
Epidemics can be really frightening, and with so much information swirling around, it's easy to panic and spread false information. In this video, you'll learn symptoms of COVID-19, how to prepare for an epidemic as an individual and an organization, how to prevent the spread of a virus in the workplace, good hygiene practices, and how to create a clear business plan to keep operations running.

Setting Up Your Remote Workspace

Working remotely has a lot of benefits, but your workspace can really impact your productivity. You want a place free of distractions, and you also want to make sure you have the right equipment. Learn how to set up a remote workspace that will help you maximize your productivity.

Conference Call Guidelines
Conference calls can be a great way to keep your dispersed team connected, but they can go south quickly. We've all had the experience of being on a conference call that wasn't a good use of time, or a dog was barking in the background, or half the team had technical difficulties. Learn best practices for having effective conference calls.

Staying Productive While Working Remotely
Remote work gives you a lot of flexibility, but sometimes that flexibility makes it hard to stay focused and productive. There are several ways to help yourself stay on task, including making a schedule, taking breaks, and more. In this video, you'll get tips on staying productive even if you're working from the couch.

Enhancing Productivity With Remote Workers
Employees might love the idea of working remotely, while managers don't like that they can't monitor or check up on employees regularly. But remote workers can be just as productive, if not more, than employees in the office. In this video, you'll learn how to manage remote employees, help them be their most productive, and the mutual benefits of remote work.
 

 

February EAP Newsletter - Be Heart Smart
View the February 2020 Issue of your EAP Newsletter 

2020 SBCs Posted
SBCs were posted for MVP PPO, MVP HMO, Emblem HMO, and CDPHP HMO.

January EAP Newsletter - Supercharge your New Year Resolutions with a Coach
View the January 2020 Issue of your EAP Newsletter 

December EAP Newsletter - Keep your calm in the super-stress season?
View the December 2019 Issue of your EAP Newsletter

Important Information for NYSHIP Enrollees:  Prescription Co-Pay Changes effective January 1, 2020:
Effective January 1, 2020, enrollees and dependents of the NYSHIP PA plan will utilize the Empire Plan Advanced Flexible Formulary.  Like the Flexible Formulary used now, the Advanced Flexible Formulary displays the most commonly utilized medications and displays excluded medications and preferred alternatives.   The formulary will be used by almost 90% of the Empire Plan enrollees and dependents.  Some of the changes on this year’s formulary will pertain to some drugs moving to the Excluded Drug List, Drugs moving to a higher tier level and Drugs moving to a lower tier level. 

Copayment changes for the Empire Plan Rx Program will be as follows:

Level 1 Copayments will remain the same

Copayment increases for Level 2 (Preferred) and Level 3 (Non- Preferred)

See Price Changes

Annual Medical Open Enrollment begins on October 7th, 2019
Medical Open Enrollment is here! During the months of October and November, District employees have the opportunity to enroll in or make changes to their health insurance plans.  All changes will become effective on January 1st, 2020.  All benefit eligible employees must complete the open enrollment process.  Please be advised that all medical elections will go through our benefit portal, INAVIGATOR.  Anyone logging into INAVIGATOR for the first time must create a user name and password to log in. Medical open enrollment ends on November 30th, so please be sure to complete the medical open enrollment before the deadline.

Employee Benefits
The following free benefits are available on a confidential basis. Counseling benefits, peak performance coaching, training and personal development benefits, self-help resources, work/life benefits, personal assistant, wellness benefits, and lifestyle benefits. To learn more download EAP benefits flyer or contact the EAP toll-free at 800.252.4555.

September EAP Newsletter - Am I Normal?
View the October 2019 Issue of your EAP Newsletter

September EAP Newsletter - Supporting Friends who Have Cancer
View the September 2019 Issue of your EAP Newsletter

Open Enrollment Flex

September 1st- September 17th, 2019 is open enrollment for the District’s Flex plan administered through Wage Works.  Enrollment is optional; however, if you are interested, then you must enroll during the designated open enrollment period.  You will not be able to enroll once open enrollment has ended. The plan year will begin on October 1st, 2019 and runs through September 30th, 2020.  We offer FSA (Flexible Spending Account) Unreimbursed Medical Expenses and DCA (Dependent Care Account). The maximum amount this plan year for FSA Unreimbursed Medical is $2700.00.  The maximum for DCA is $5000.00 per household. Enrollment must be completed through INAVIGATOR. September is also the open enrollment month for Aflac. This is the time when you can add or drop an Aflac policy. Information will be available on INAVIGATOR starting on 9/1/19. Please check your 8/30/19 email for enrollment details.

August EAP Newsletter - Save Money with your EAP
View the August 2019 Issue of your EAP Newsletter

Agreement with Westchester Medical Center Health Network Reinstated Retroactive to June 1, 2019

The Westchester Medical Center Health Network (WMCHN) and Empire BlueCross (the Hospital Program administrator) reached a contract agreement that reinstates the hospital system’s network status retroactive to June 1, 2019. WMCHN includes the following facilities: Bon Secours—Good Samaritan Hospital; Bon Secours—Mercy Community Hospital; Bon Secours—St. Anthony’s Hospital; Mid-Hudson Regional Hospital and Westchester Medical Center.

Claims for services received at these facilities on or after June 1, 2019 will be processed as in-network and will be subject to in-network copayment, where applicable.  If preadmission certification was received for a future hospital admission, services will be approved for an in-network level of benefits and the corresponding claim will be subject to in-network copayment, where applicable.

If enrollees have any questions, please have them call 1-877-7-NYSHIP (1-877-769-7447) and select option 2 for the Hospital Program.

 

2019-2020 Health Insurance Buy-Out May -1 June 14th, 2019

Information will be going out in May 2019 via district email regarding our Open Enrollment period for the Health Insurance Buy-Out.  If you are taking the medical buy-out for the 2019-2020 school year, you must log into the INAVIGATOR benefit portal and enroll in the health insurance buy-out online. In addition, you must also upload a copy of your current health insurance ID card to the INAVIGATOR portal.  The health insurance buy-out open enrollment period runs from May 1, 2019- June 21, 2019.  You must complete the buy-out enrollment each year that you are electing to enroll in the medical buy-out.  Please remember there is a June 14, 2019 deadline.  Enrollments not received by that date will not receive the 2019-2020 health insurance buy-out in the first pay of October 2019.

 

EAP Coaching Programs Available (Click Image To Download)

Flyer Graphic-Open PDF for all content 

2018 Holiday Survival Toolkit from our EAP

We wish you all the joys of the season and the best for the New Year! And to help ensure that your holidays stay happy, we have included a 2018 Holiday Survival Toolkit, with links to tools on navigating stress, budgets, family dynamics, holiday health and more.

While the holidays can be full of rich time with family and friends, they can also be a time of high stress or depression for some, such as those who are struggling financially, those who have suffered a recent loss or any number of other reasons. If you or a family member are experiencing any difficulties this season, large or small, your EAP can help.

Remember that your EAP is available 24-7-365 for help with any difficulties you may experience. For confidential help from experienced counselors simply call 800.252.4555.

Important Information for NYSHIP Enrollees concerning copayment increases.

The following information concerns changes to the Empire Plan copayments for Medical, Hospital, and Mental Health and Substance Abuse Services, and to the combined annual deductible and coinsurance maximum amounts for non-network services. These changes were negotiated by State employee unions that settled their collective bargaining contracts with New York State or the Unified Court System and they are being extended to Participating Agencies (PAs) and Participating Employers (PEs). These changes are effective January 1, 2019 and apply to PA and PE enrollees who are active employees, retirees, dependent survivors or COBRA enrollees with Empire Plan Benefits. See Full Notice including Charts

 



Contact Health Benefits

Keisha Martinez, Health Benefits Specialist
BOE/ Library Complex
124 Grand Street

Phone: 845-563-3467

Important Phone Numbers

Service Phone
Empire 1-877-769-7447
MVP 1-888-687-6277
CDPHP 1-800-777-2273
GHI 1-877-244-4466
CSEA Dental/Vision 1-800-323-2732
Marshall & Sterling 1-914-962-1188 
ext 2481 or 2489 
NYSLRS
osc.state.ny.us 
1-866-805-0990

1-518-474-7736

NYSTRS
www.nystrs.org
1-800-348-7298
Health Equity

 formerly WageWorks

(Flex/FSA /DCA)

my.healthequity.com

1-877-924-3967
Aflac
Jennifer Boulle 
845-337-2134
Educators' EAP  1-800-252-4555 or 1-800-225-2527
Important Documents and Files

SUMMARY OF BENEFITS
2022 NYSHIP Summary of Benefits (SBC)
2022 MVP PPO SBC 
2022 CDPHP SBC
2022 Emblem Health SBC
2022 MVP HMO SBC 

 
NTA BENEFIT TRUST FUND FORMS
Visit NTA Website


GENERAL FORMS AND DOCUMENTS
2022 General Notices 
2022 Insurance Marketplace Information 
2022 Department of Labor CHIP Notice 
Drug Coverage and Medicare Notice
Health Coverage and Medical Terms
Change of Address
Cancer Screening Leave Form
Family & Medical Leave Act Form for Families 
Family & Medical Leave Act Form for Self 
EAP Benefits Flyer


WAGE WORKS FLEX PLAN
2021 Flex FSA Updated Information 
2021 FSA Claim Form for Unreimbured Medical
2021 Dependent Care Claim Form
FSA OTC Eligible Items
FSA Dependent Care Info

 

EMPIRE FORMS
Statement of Dependence PS457
Empire Enrollment Form PS503.1
Dependent up to age 26 Form
Disability Form PS451
Empire Claim Form - Non-Partic. Providers
for more forms visit CS.STATE.NY.US


MVP FORMS
2022 MVP PPO Benefits Guide
2021 MVP PPO Health Risk Screening Form 
2021 MVP PPO Mom's Meals Program
2021 MVP PPO Wellstyle Rewards Program 
2021 MVP PPO  Rewards Reimbursement  
2021 MVP PPO GIA Program
2021 MVP PPO Gia Registration 
2021 CVS Caremark Pharmacy Mail Order Form
MVP PPO Rx Claim Reimbursement
MVP PPO Account Setup & HRA Mngm.
MVP HRA Claim Form
HMO Enrollment Change Form
PPO Enrollment Change Form 
for more forms visit... JoinMVP.com

 

GHI FORMS
visit GHI.com


EMBLEM
Emblem Enrollment Form
Emblem Insurance Claim Form
Emblem Prescription Claim Form


CDPHP
CDPHP Enrollment Form
visit CDPHP.com

 

 

 

 



QUICK CONTACT

Main Switchboard
845.563.3400
Food Services
845.563.3424
Registration
845.563.5437
BOE Clerk
845.563.3503
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845.568.6833
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845.563.3440
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845.563.5420
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SCHOOLS

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845.563.8550
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Temple Hill
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845.563.7900
Heritage Middle
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South Middle
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