Online Application



If you experience a qualifying change in status event during the plan year and wish to enroll, change your current election, or terminate your deductions, you will need to submit a change in status application. If you aren’t already a 2020 plan year participant, you will need to complete the New Participant Registration process and create your login credentials before you can complete your application. Change in status applications for the 2020 plan year will be accepted within 60 days of your qualifying event but no later than November 1, 2020. Click on the 2020 CHANGE IN STATUS button below to complete your application.

DCAA Change in Status Information 

HCSA Change in Status Information 

Make sure to:

  • Read the benefit descriptions carefully before submitting your application
  • Have a copy of your most recent paystub since you will need your NYS EMPLID, Department ID, and Negotiating Unit code to complete your application
  • Call Customer Service at 800-358-7202 if you need assistance or want to complete your application by telephone