NYC Health Benefits Program


Important Notice

The Health Benefits Retiree client service walk-in center is closed. Please resubmit your documents as follows:

1) Forms/documents can submitted electronically using the following link: https://nycemployeebenefits.leapfile.net

For detailed instructions on how to submit your form/document securely through LeapFile and to view a short video, click here.

Please do not submit your form/document more than once. This will only delay processing.

You will immediately receive notification stating "Success! Your file has been received" upon completion of your document upload.  You will not receive a separate email confirmation.

Please allow 30-45 days from the day you submit your document(s) for them to be processed. Coverage will be retroactive to the effective date of retirement.

2) Forms and documents can be mailed to:

NYC Office of Labor Relations
Health Benefits Program
22 Cortlandt Street, 12th Floor
New York, NY 10007

3) Inquiries and questions can be emailed to healthbenefits@olr.nyc.gov - do not send forms through email (see #1 and #2 above)

4) For questions regarding the PICA prescription drug benefit program please call 1-800-467-2006.

5) If you are a HIP-HMO member turning 65 or on Medicare due to a disability, please contact HIP at (800) 447-9169 to enroll over the phone. Please identify yourself as a City of New York retiree or dependent of a retiree. For all other members enrolled in a HMO plan, please contact your health plan at the customer service numbers on the back of your ID card.

Please check our website periodically for updates.


Health Benefits Forms & Downloads

Health Benefits Summary Plan Description (SPD)

Health Benefits Application/Change Form (Not for use by NYCAPS Agencies)

Health Plan Rate Chart for Retirees

Retiree Change of Address Form

COBRA Form, Notice of Rights and COBRA Rates - January 2022

COBRA Form, Notice of Rights and COBRA Rates - July 2021

Young Adult Option Through Age 29 (NYS Law Chapter 240) - January 2022

Young Adult Option Through Age 29 (NYS Law Chapter 240) - July 2021

Domestic Partner Enrollment Information


Medicare Part B Reimbursement

Medicare Part B Reimbursement Q&A

Medicare Part B Reimbursement Program Application

2021 Medicare Part B Reimbursement - The reimbursement for the standard Medicare Part B was $1,782.00. Any premiums paid above the standard amount should be submitted using the  IRMAA 2021 Application.

2020 Medicare Part B Reimbursement - The reimbursement for the standard Medicare Part B was $1,735.20. Any premiums paid above the standard amount should be submitted using the  IRMAA 2020 Application.

2019 Medicare Part B Reimbursement Differential Request Form

2018 Medicare Part B Reimbursement Differential Request Form

2017 Medicare Part B Reimbursement Differential Request Form


IRMAA Medicare Part B Reimbursement

IRMAA Medicare Part B Reimbursement Application (for 2021, 2020, 2019)

IRMAA Medicare Part B Reimbursement Application (2018)


Creditable Coverage Notice (Employees Age 65 or Over)

Form 1054 (For Use By Authorized Personnel Only)

Health Insurance Marketplace (Exchange) Notice