1. Please complete and sign the Medicare Supplement Application.
2. Deposit for first month's premium payable to NYCDS Member Benefits.
3. Please return all materials to:

NYCDS
50 Whitecap Dr.
North Kingstown, RI 02852
Attention: Customer Care Center

Business Rules:

Billing Rules

• Groups are billed 10-14 days in advance
• Payments are due on 1st of every month
• Payments cannot be applied to lapsed/termed policies
• Past dues are generated on 10th of every month
• Payments are applied every business day to each active account
• Lapse notices are processed on the 1st of the month following the lapsed month (eg. 5/1/00 we will lapse for April's uncollected premium)
• There is a 30 day grace period for remitting premiums