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New York Document Library
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Miscellaneous Forms
New York Underwriting Guidelines (PDF)
New York Small Group Employer Application - for use 1/1/08 (PDF)
Membership Applications (PDF)
Certification Form (PDF)
Small Employer Health Benefits Waiver of Coverage (PDF)
Late Paperwork Form (PDF)
CAF 1 (PDF)
CAF 4 (PDF)
HIPAA Authorization (PDF)
(for claim inquiries)
Supply Request Form (PDF)
General Agent Contact List (PDF)
New York Benefit Summaries
New York Quarterly Rate Sheets
Plan Comparison Grid 2005 (PDF)
HMO Plan O (PDF)
HMO Plan P (PDF)
Open Access Plus Plan A (PDF)
Open Access Plus Plan B (PDF)
Open Access Plus Plan C (PDF)
Open Access Plus Plan D (PDF)
Open Access Plus Plan E (PDF)
Open Access Plus Plan F (PDF)
Open Access Plus Plan G (PDF)
Open Access Plus Plan J (PDF)
Open Access Plus Plan K (PDF)
Open Access Plus Plan L (PDF)
Open Access Plus Plan M (PDF)
Open Access Plus Plan N (PDF)
High Deductible Health Plan (HDHP) 1:90% / 2000 (PDF)
High Deductible Health Plan (HDHP) 2:90% / 2500 (PDF)
High Deductible Health Plan (HDHP) 3:90% / 3000 (PDF)
High Deductible Health Plan (HDHP) 4:100% / 3000 (PDF)
Open Access Plus Plan A1 (PDF)
Open Access Plus Plan B1 (PDF)
Open Access Plus Plan C1 (PDF)
Open Access Plus Plan D1 (PDF)
Open Access Plus Plan E1 (PDF)
Open Access Plus Plan F1 (PDF)
Open Access Plus Plan G1 (PDF)
Open Access Plus Plan J1 (PDF)
Open Access Plus Plan K1 (PDF)
Open Access Plus Plan L1 (PDF)
Open Access Plus Plan M1 (PDF)
Open Access Plus Plan N1 (PDF)
High Deductible Health Plan (HDHP) 1A:90% / 2000 (PDF)
High Deductible Health Plan (HDHP) 2A:90% / 2500 (PDF)
High Deductible Health Plan (HDHP) 3A:90% / 3000 (PDF)
High Deductible Health Plan (HDHP) 4A:100% / 3000 (PDF)
NY 1st Qtr 2008 Rate Sheet (PDF)
NY 2nd Qtr 2008 Rate Sheet (PDF)
NY 3rd Qtr 2008 Rate Sheet (XLS)
New York Underwriting Guidelines (PDF)