Health Insurance – Open Transfer Instructions

  • If you do not wish to make any changes, no action is required.

    If you are currently enrolled in health coverage and wish to transfer to another insurance carrier, please download* the appropriate health enrollment form for the plan you wish to transfer to. All changes will take effect January 1, 2021.

    If you are currently enrolled in health coverage and wish to waive your coverage, download* a Health Declination form. All changes will take effect January 1, 2021.

    If you currently waive your health coverage and would like to enroll, download* the appropriate health enrollment form for the plan you wish to enroll in.  Enrollment will become effective after a three-month waiting period, unless you can prove that coverage under another health plan has been recently terminated. Copies of the following documents are required when enrolling in a health plan offered by Nassau BOCES.

    Individual Coverage Family Coverage
    Birth certificate Birth certificate for yourself and each dependent
    Social Security card Social Security card for yourself and each dependent
      If you are applying for coverage for your spouse, you must also present your marriage certificate.
      Also, you must provide proof of current joint ownership/joint financial obligation. You must submit a copy of the first page of last year's joint tax return, or a copy of a current joint bank statement or joint mortgage statement or a joint homeowner's policy.

    If you are interested in changing your Cafeteria Plan option, download* the Cafeteria Plan Election form. All completed forms must be returned to the Department of Human Resources, Attn: Kathy Reilly by January 4, 2021.

    Completed forms can also be securely uploaded using the link at the bottom of your Open Transfer email; returned via mail to 71 Clinton Road, Garden City, NY 11530, Attn: Kathy Reilly; or faxed to 516-997-2051.

    *You must download and save the appropriate form to your computer. Once saved, open the form, complete it, save it again, then upload it to the secure link, otherwise we will receive a blank form.

    Under the state’s Electronic Signatures and Records Act (ESRA), electronic records and signatures have the same validity and effect as if handwritten.