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Nassau County, NY
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  6. Active Employees Forms

Active Employees Forms

Active employees should contact their Department's Human Resources for all inquiries regarding health insurance.

Emblem Health VYTRA Enrollment Form (PDF)
Aetna Enrollment or Change Form (PDF)
Buy Back Application (PDF)
Emblem Health HIP HMO Enrollment Form (PDF)
Buy Back Instructions (PDF)
NYSHIP Out of Network Claim Form (PDF)
Smart Savings Reimbursement Form (PDF)
NYSHIP Disabled Dependent Form (PDF)
Smart Savings Procedures (PDF)
NYSHIP Statement of Dependence Form (PDF)
Davis Vision Enrollment Form (PDF)
Flex Spending Account Health Care and Dependent Care Enrollment Form (PDF)
Dentcare Reimbursement Claim Form (PDF)
Documentation Required to Enroll Dependent(s) (PDF)
Dentcare Enrollment Form (PDF)
HMO Enrollees Statement of Dependence Form (PDF)
Domestic Partner Form (PDF)
Young Adult Option Coverage (PDF)
Change of Address Request Form (PDF)
NYSHIP Health Insurance Transaction Form (PDF)
Termination of Domestic Partnership
NYSHIP Dependent Tax Affidavit for Enrollment Form (PDF)


Contact Us

  1. Email the Comptroller's Office
    Ph: 516-571-2386

    Nassau County Comptroller's Office
    240 Old Country Road
    Mineola, NY 11501


    Contact Us

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FAQs

  1. How do I determine if a vendor is already in the County’s master vendor file?
  2. How can a vendor be added to the County list?
  3. Can I make a change to a purchase order that has already been approved?
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