Common Forms for Employers
Find common forms, tools, and resources for large group and small group plans across New York State and Vermont.
General Employer Tools and Resources
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Employer Forms
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Large Group Forms
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Small Group Forms
- Attestation for Eligibility For Small Group Products
- Attestation for Eligibility For Small Group Products (Fillable)
- Grandfathered Plan Status Certification
- Grandfathered Plan Status Certification (Fillable)
New York Small Group Forms
- New York Small Group Application HMO
- New York Small Group Application EPO/PPO
- New York Small Group Recertification Form
- New York Small Group Recertification Form (Fillable)
- Enrollment/Change Form — New York Small Group HMO
- Enrollment/Change Form — New York Small Group EPO/PPO
Healthy New York Forms
- Healthy New York Small Group Application
- Healthy New York Small Group Recertification Form
- Healthy New York Small Group Recertification Form (Fillable)
- Enrollment/Change Form — Healthy New York
Vermont Small Group Forms
- Attestation for Eligibility For Small Group Products
Creditable Coverage Forms
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2023
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2022
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2021
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2020