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www.cs.ny.govIRMAA reimbursement for both the enrollee and dependent will be issued to the enrollee only. In order for the Employee Benefits Division to speak with a dependent regarding the IRMAA application, the enrollee must complete and sign the NYSHIP Authorization for Release of Protected Health Information Form (EBD -543).
New York City Office of Labor Relations Health Benefits ...
www1.nyc.govNew York City Office of Labor Relations . Health Benefits Program . nyc.gov/olr. Medicare Part B IRMAA Reimbursement Form . The City of New York Health Benefits Program reimburses Medicare- eligible retirees and their Medicare -eligible dependents for any