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
- Affidavit of Group Sponsored Coverage for Common Law Employees
- Affidavit of Group Sponsored Coverage for Common Law Employees (Fillable)
- 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- New York Small Group Application HMO (Fillable)
- New York Small Group Application EPO/PPO (Fillable)
- New York Small Group Recertification Form
- New York Small Group Recertification Form (Fillable)
- Enrollment/Change Form — New York Small Group HMO (Fillable)
- Enrollment/Change Form — New York Small Group EPO/PPO (Fillable)
Healthy New York- 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- Vermont Small Group Application Form (Fillable)
- Vermont Small Group Recertification Form
- Vermont Small Group Recertification Form (Fillable)
- Enrollment/Change Form — Vermont Group Plan (Fillable)
- 2024 Vermont Small Group Plan Selection Form
- 2024 Vermont Small Group Plan Selection Form (Fillable)
- 2023 Vermont Small Group Plan Selection Form (Fillable)
Creditable Coverage Forms
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2024
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2023
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2022
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2021
Tools and Resources for Medicare Plans
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