Request New Card To request a replacement card, please use the form below, and we will follow up with you as soon as possible. For immediate assistance or if you have any questions, please call our office at (315) 782-9000. Your Full Name Full Company/Employer Name Street Address City State Zip Code Valid Email Address Phone Number Type of Coverage Type of Coverage Medical Dental Vision HSA/HRA/FSA 10 + 4 = Request Card
