Benefits Fund Electronic Disclosure

The NYSNA Benefits Fund has taken steps to make it easier for participants to access and review important required Benefits Fund documents and notices on this website at your convenience without filling up your mailbox with extra mail. If you consent to receiving these Fund documents electronically, you will no longer receive paper copies in the mail. These documents include:

  • Summary Annual Report
  • Summary Plan Description and applicable Summary of Material Modifications
  • Summary of Benefits & Coverage

Once you have consented to Electronic Disclosure, each time a new required document or notice listed above has been posted to this website , the Benefits Fund will notify you via email so that you may access and view it at your convenience. Only participants who have supplied the Benefits Fund with a reliable and valid personal email address for our files are eligible for this program. If you’re unsure that we have your most current email address on file, please contact the Fund office at (877) RN BENEFITS (762-3633) or by email at benefitsdepartment@rnbenefits.org.

Providing your consent to electronic disclosure of Benefits Fund documents is simple! Just choose one of the submission options below to get started.

The "Online Form Completion and Submission" option is the easiest way to sign your consent form quickly and securely online and submit it directly to the Benefits Fund office without the need to download and print the form or mail it through the U.S. Postal Service. If you prefer, however, you may also download the form, complete it manually, and then either email, fax, mail, or securely upload the form to the Fund office.

If you do not submit a consent form, the Benefits Fund will continue sending paper versions of these required documents to you through the U.S. Postal Service.

Online Form Completion and Submission

This is the easiest way to complete and submit your consent to the Fund. The Benefits Fund uses DocuSign to provide secure submission of your beneficiary information. Part of this process requires a verification procedure (Knowledge-based Authentication or KBA) to confidentially verify your identity. We don't retain any of your personal information during this process.

 

  1. To begin, click the button below.
  2. You must enter some simple personal information for KBA purposes, including your name, address and, for best results, your date of birth or social security number.
  3. Click "Next."
  4. Answer the series of identification-related questions, which will verify your identity.
  5. If your identity is successfully verified, you will be directed to the document for completion. In addition, an email will be sent to you for the option to complete the document later, however, doing it immediately is always the best option.
  6. Click “Continue.”
  7. Review the “Electronic Record and Signature Disclosure” and check the checkbox indicating your agreement to receive and sign the document electronically.
  8. Click "Continue."
  9. Click the “Start” tag when you are ready to fill out the form.
  10. Click the "Continue" button to fill in all the required question fields. There are required and optional fields. Please complete as many optional fields as possible.
  11. You will need to “Adopt a Signature” by typing or drawing your signature. Click “Adopt Signature” to accept the signature and then click “Apply Signature” to add it to your form.
  12. Click the “Finish” button to submit your form to the Plan. You will be given the option to download the form for your records and an email with the completed documents will be sent to you.

Paper Form Completion and Submission

Begin by downloading, printing, and completing the form.

Download Form

Once you've completed the form and signed it, use one of the methods below to submit the completed form.

Mobile Upload

This is the easiest way to provide your signed consent form to the Fund. Use the button below to access our secure upload site. Use the "Browse files" link to use your camera to take a photo and upload it in one step.

 

Submit via email

Simply sign your paperwork, take a picture, and email it to benefitsdepartment@rnbenefits.org using the link below.

 

Submit via fax

Fax your signed paperwork to (518) 869-2317.