Emergency Enrollment

Emergency Enrollment Card

DO NOT USE THIS PAGE UNLESS YOU WERE REFERRED TO IT BY A CIR BENEFITS REPRESENTATIVE.

In situations where immediate enrollment is necessary, you may download a temporary enrollment card here and fax or mail it to the Benefits Office. It is the policy of the CIR Benefits Plan that you must also complete an official Enrollment Card which you can request from the Benefits Office at 212-356-8180.

In order to enroll you and any eligible dependents in the CIR/SEIU Benefits Plan, You must complete all sections of the CIR Benefits Enrollment Card:

HHC Only Membership Card (Blue Card)

All Other Hospitals Membership Card (White Card)

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