Please use the links below to download the EmblemHealth Insurance forms, applications, or information you need.
EmblemHealth Insurance Downloads
- Claim Form - Health Insurance
- Claim Form - Rx
- COBRA Form
- Domestic Partnership Declaration
- Gym Reimbursement Form
- Incapable Dependent Child Certification Form
- Late Paperwork Form
- Letter of Certification - Sole Proprietor
- Submission Checklist
- Waiver of Coverage Form
- Young Adult Election-Eligibility Form
- Claim Form
- Small Group Late Submission Acknowledgement Form
- Waiver Form
- Benefit Description - Employee Assistance Program
- Benefit Description - Rx Program FAQs (an excerpt from EmblemHealth FAQs)
- Benefit Description - Women's Preventive Services - Effective 8-1-12
- EmblemHealth ACP Information
- EmblemHealth Teladoc Information
- 2023 Small Group Bronze Plus HSA
- 2023 Small Group Bronze Premier
- 2023 Small Group Gold Premier
- 2023 Small Group Platinum Premier
- 2023 Small Group Silver Plus HSA
- 2023 Small Group Silver Premier
- 2024 Individual Underwriting Guidelines
- 2024 Individual Plan Summaries
- 2024 Individual Bronze Plus HSA Plan Summary
- 2024 Individual Bronze Premier Plan Summary
- 2024 Individual Platinum Premier Plan Summary
- 2024 Individual Gold Premier Plan Summary
- 2024 Individual Silver Plus HSA Plan Summary
- 2024 Individual Silver Premier Plan Summary