Optical, Hearing Aid & Tax Voucher Requests

* These Fields Must be Filled in for your Request to be Processed

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I am requesting a * voucher *

The person(s) I would like the voucher(s) for is (are):

Member Information

Member ID (BF#) or Last 4 Digits of SS# *

Member's Last Name *

Member's First Name *

Middle Initial

Date of Birth (format: MM-DD-YYYY) *

Mailing Address *

City *

State *

Zip Code *

Member's Personal E-mail *

Day Telephone *

Telephone Type *

Pick Up? *

* These Fields Must be Filled in for your Request to be Processed

SUBMIT ONLY ONE FORM PER VOUCHER TYPE

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If you have any questions please contact the Fund at 631-319-4099 or email us at Inquiry@scmebf.org. (Please put "Fund Question" in the subject line)

Keep in mind we will not be able to answer personal claim information due to the HIPAA laws. You will need to call us and have your PIN or BF# handy.

The Suffolk County Municipal Employee Benefit Fund

Hours of Operation

Mon – Thu: 8AM – 5PM
Fri: 8AM – 4:30PM

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