Forms MUST BE RECEIVED no later than November 18, 2022 and should be submitted either:
- Via email to: EmployeeBenefits@ongov.net using “Open Enrollment” or “OE” in the subject line
- To your department Payroll Clerk
- To the Employee Benefits office via interoffice or US mail to: Employee Benefits, 421 Montgomery St. 15th Floor, Syracuse NY 13202
Questions can be submitted by email to EmployeeBenefits@ongov.net or you may call the benefit office at 315-435-3498.
Health/Dental Insurance Enrollment/Change Form
Flexible Spending Enrollment Form
Student Dependent Certification Form (for dental coverage for children ages 19-26) Please use this form only if you need to re-enroll your student. Everyone that is currently enrolled will receive a new form in January.
Long Term Disability Request for Information (you must request this information as rates do vary by union and salary)
Health and Dental Rates: 2023 Rates
IMPORTANT: If enrolling any dependents on your Health/Dental plan, documents proving dependent eligibility MUST be submitted with your application. Addition of spouses require copy of marriage certificate. Addition of children require copy of the birth certificate(s). Addition of children between the ages of 19-26 to the dental plan also require a completed student dependent certification form. Applications sent without dependent documentation will not be processed.
Please note that any enrollment/change forms for Deferred Comp or Short Term Disability should be sent directly to the vendor. Employee Benefits does NOT manage those programs and cannot accept forms for those programs. Please refer to our “Other Benefits” page for more information.