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Benefits Information

Health Insurance Marketplace Notice

Declination of Health and/or Dental/Vision Benefits

HIP 2017 Summary of Benefits


Announcement Letter

Dental Claim Form

Vision Claim Form

The Empire Plan

The Empire Summary of Benefits and Coverage is available at

If you do not have internet access, call 1-877-769-7447 and select Option 1 for the Medical Program to request a copy.



Access to search for participating providers

Health Claim Form

Life Insurance

Designation of Beneficiary

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