New York City Health + Hospitals
Benefits & Forms
Personal information:
- Membership Forms are available on individual hospital pages. Select your hospital from the Benefits page.
- Update Form – To add new dependents to your plan. Requests to add dependents must be received within 30 days of qualifying event (birth/adoption or marriage), and you must attach requested documentation (see form).
- Domestic Partnership Application (same-sex and opposite partners eligible) – To add a partner, download an application and return a notarized copy, along with all requested documentation, to the Plan office. You must also complete an Update Form above.
- Opt-Out Benefits Form – Please fill out this form if you would like to remove yourself and/or your dependent(s) from the CIR Benefits Plan.
Disability:
For purposes of our disability benefits, “disabled” means you can no longer perform the duties of your occupation due to accidental bodily injury, sickness, or a related medical condition, including pregnancy or childbirth. You must also be under the care of a licensed provider as defined by the state in which you work.
- Disabled Health Premium Reimbursement
- Short-Term Disability (STD) Benefits Claim Form
- Coverage begins on the eighth (8th) day of your disability. The maximum benefit payable is 70% of your weekly salary, up to $875 per week, for up to 26 weeks. See the Summary Plan Description (SPD) for more details.
- If you are going out on a disability leave, contact your employer as soon as possible.
- Long-Term Disability (LTD) Benefits Claim Form
- The LTD plan pays you 70% of your monthly salary, up to a maximum of $3,500 per month. LTD benefits typically start if you are still disabled after 26 continuous weeks. For detailed information on Long-Term Disability see the Guardian Certificate.
- INSMED Portable Disability Coverage – Policies offered to you without any medical underwriting requirements or exams.
Life Insurance:
- Guardian Life Insurance – If you die, a death benefit of $150,000 will be paid to any beneficiary you name. A death benefit of $20,000 will be paid to you if your legal spouse or domestic partner dies from any cause.
- Life Insurance Conversion Form – When you terminate employment, you will have the option to convert this benefit to an individual policy, subject to certain conditions.
Education:
- Continuing Learning Program (CLP) Claim Form allows reimbursement for medical conferences, board review courses, and online courses. You can still attend conferences or take online courses up to six months after graduation, if you pay for them while on your hospital’s payroll. See the Summary Plan Description (SPD) for more details.Effective July 1, 2020-June 30, 2021, you can put your CLP balance towards your Professional Education Plan (PEP).
- Professional Educational Plan (PEP) Claim Form reimburses costs associated with books, board exams, medical licensure fees, dues, subscription, journals and mobile electronic medical devices. See the Summary Plan Description (SPD) for more details.Effective July 1, 2020-June 30, 2022, you can be reimbursed for work-from-home-related equipment like tables, computers, monitors and printers under PEP.
- QI Training & Education Application
- QI Training & Education Reimbursement Form (For those who have been previously approved for this benefit)
- Rosetta Stone – opportunity to learn a new language with Rosetta Stone.
Childcare:
Are you a resident or fellow in need of childcare? You’re in luck!
Housestaff with children 13-years-old or younger are eligible for reimbursement of up to $3,500 per calendar year as of July 1, 2019 for childcare expenses.
To qualify:
- You must be a resident or fellow at a New York Health + Hospitals (NYC H+H) facility
- Your child or children must be 13-years- old or younger
- Your expenses must qualify as tax- exempt per IRS Publication 503
- Submit a reimbursement form with paid receipt and other required documentation
You can fill out a reimbursement form and find more info below:
COBRA:
COBRA (continued health insurance after hospital closure or layoff). If you are electing COBRA for the first time, you must complete the Election Form. If you are changing or updating an existing credit card, complete the Payment Form only.
Patient Care Trust Fund:
As part of our mission to improve patient care and safety, the PCTF provides multiple grants to CIR members for research, equipment, educational materials, and more.
Appeal & Claim Reprocess Forms:
- Appeal Claim Form – Complete this form if your claim was denied in whole or any part or if you disagree with the decision that was made.
- Claim Reprocess Form – Complete this form if your claim was denied and you are able to provide additional information.
Resources:
- View a comprehensive summary of all available benefits, plus the addendum.
- View discount programs on the main Members page.
Additional Benefits
Regional Vice Presidents
Noah Berland, Emergency Medicine, Kings County Hospital Center
Linelle Campbell, Emergency Medicine, Jacobi Medical Center
Oluyemi Omotoso, Emergency Medicine, Lincoln Medical & Mental Health Center
Contact CIR Staff
Bellevue, Coney Island, Lincoln
Dominic Desmond
Ddesmond@cirseiu.org
917-273-6472
King’s County
Lalit Clarkson
Lclarkson@cirseiu.org
917-902-7253
Harlem, Woodhull
Alphonso Nyenuh
Anyenuh@cirseiu.org
646-689-3304
Jacobi, Metropolitan
Andrew Porter
Aporter@cirseiu.org
917-747-0430