mbf-forms-and-downloads

Office of Labor Relations


Employee Asst Pgrm Flex SpendingMgmt Benefits VDC Program

MBF Videos
Basic Life and AD&D Insurance
Group Universal Life Insurance (GUL)
Long Term Disability (LTD) Insurance
Superimposed Major Medical
Dental
Vision
Survivor Benefits
COBRA
Medical Leave and Special Leave of Absence
Health and Fitness Reimbursement
Retiree, Senior Drug Subsidy Benefits
MBF Forms & Downloads
MBF Frequently Asked Questions
Email MBF

MBF Videos

Basic Life and AD&D Insurance

Group Universal Life Insurance (GUL)

Long Term Disability (LTD) Insurance

Superimposed Major Medical

Dental

Vision

Survivor Benefits

COBRA

Medical Leave and Special Leave of Absence

Health and Fitness Reimbursement

Retiree, Senior Drug Subsidy Benefits

MBF Forms & Downloads

MBF Frequently Asked Questions

Email MBF


The Management Benefits Fund

Important Notice

Please submit your forms and documents as follows:

1) Inquiries and questions can be sent via email to the Fund

2) Forms and documents can be submitted electronically to: https://nyc-mbf.leapfile.net

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.

View step-by-step instructions and video.

3) Mail completed forms/documents to:
NYC Management Benefits Fund
P.O. Box 707
Bowling Green Station
New York, NY 10274

4) Express mail forms/documents should be sent to:
NYC Management Benefits Fund
22 Cortlandt Street, 28th Floor
New York, NY 10007

Please check back periodically for updates.

MBF Program Guides, Brochures & Forms

Complete MBF Booklet

MBF Booklet

MBF Booklet Sections

General Information

Basic Life Insurance and AD&D

COBRA

Dental Benefits

Family and Medical Leave Act (FMLA)

Fund Eligibility and Membership

GHI Senior Care Drug and Medicare Supplement Health Plan Rider Subsidy Benefit

Group Universal Life (GUL) Insurance

Health and Fitness Reimbursement Program

Long-Term Disability (LTD) Insurance

Retiree Medicare HMO Drug Benefits

Special Leave of Absence Coverage (SLOAC)

Superimposed Major Medical Plan (SMMP) Benefits

Survivor Benefits

Vision Care Benefits

Management Benefits Fund Forms

Young Adult Dependent Direct Pay Coverage Continuation (DPCC) Form - October 2024

COBRA Application - October 2024

ASO Dental Claim Form (for use January 1, 2023 or after)

Health and Fitness Reimbursement Claim Form

Health and Fitness Claims Reimbursement Direct Deposit Form For Retirees Only

Superimposed Major Medical Claim Form

Superimposed Major Medical Part D Form

Superimposed Major Medical Family Building Benefit Reimbursement Forrm

Vision Care Claim Form - GVS

Vision Care Worksheet - GVS

MBF HIPAA Form

HIPAA Rights (MBF Only)

HIPAA Rights (For MBF only)

Lost Check Claim

To submit a claim for a lost check from the Management Benefits Fund, the Dependent Care Assistance Program, or the Health Care Flexible Spending Account Program.

Lost Check Claim Form