Resources for Brokers & Consultants
Plan Information, Applications, References & Online Quoting Support
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
- Underwriting Guidelines - Small Group 2018
- Waiver of Coverage Form
- Young Adult Election-Eligibility Form
- 2019 Small Group Member Change Form
- 2017 Employee App and Transaction Form
- 2018 Small Group Application
- Enrollment Application - Large Employer Group - Employer
- Individual Enrollment Form 2017
- Individual Enrollment Form 2018
- Small Group Application 2018
- 2019 Individual Application
- 2019 Small Group Employer Application
- 2019 Small Group Employee App/Transaction Form
- 2018 Formulary Individual
- 2018 Formulary Small Group
- 2018 Individual Bronze Benefit Summary
- 2018 Individual Bronze Value Benefit Summary
- 2018 Individual Catastrophic Benefit Summary
- 2018 Individual Gold Benefit Summary
- 2018 Individual Platinum Benefit Summary
- 2018 Individual Silver Benefit Summary
- 2018 Individual Silver Value Benefit Summary
- 2018 Small Group Bronze HSA Benefit Summary
- 2018 Small Group Bronze Value Benefit Summary
- 2018 Small Group Gold 40/60 Benefit Summary
- 2018 Small Group Gold Open Access Benefit Summary
- 2018 Small Group Platinum 15-35 Benefit Summary
- 2018 Small Group Silver Value Benefit Summary
- Benefit Description - Dental - 2018 Small Group Bronze Value
- Benefit Description - Dental - 2018 Small Group Gold Open Access
- Benefit Description - Dental - 2018 Small Group Silver Value
- Benefit Description - Employee Assistance Program
- Benefit Description - Rx Program FAQs (an excerpt from EmblemHealth FAQs)
- Benefit Description - Value Added Healthful Choices Programs
- Benefit Description - Vision Program - Davis Vision
- Benefit Description - Women's Preventive Services - Effective 8-1-12
- Bronze Value Dental Plan
- Gold Open Access Dental Benefits
- Select Care Hospital List
- Select Care vs Prime Network Comparison
- Silver Value Dental Benefits
- 2019 Small Group Platinum Choice Benefit Summary
- 2019 Small Group Healthy NY Gold Benefit Summary
- 2019 Small Group Silver Premier Benefit Summary
- 2019 Small Group Bronze Plus HSA Benefit Summary
- 2019 Small Group Gold Premier 1 Benefit Summary
- 2019 Small Group Silver Choice Benefit Summary
- 2019 Small Group Silver Plus 1 Benefit Summary
- 2019 Small Group Silver Plus Benefit Summary
- 2019 Small Group Silver Premier 1 Benefit Summary
- 2019 Small Group Gold Value Benefit Summary
- 2019 Small Group Gold Choice Benefit Summary
- 2019 Small Group Silver Value Benefit Summary
- 2019 Small Group Platinum Premier Benefit Summary
- 2019 Small Group Gold Premier Benefit Summary
- 2019 Small Group Gold Plus Benefit Summary
- 2019 Small Group Bronze Value Benefit Summary
- 2019 Small Group Gold Plus 1 Benefit Summary
- 2019 Small Group Plan Overview
- 2019 Individual Catastrophic Plan Benefit Summary
- 2019 Individual Bronze Benefit Summary
- 2019 Individual Gold Benefit Summary
- 2019 Individual Gold Value Benefit Summary
- 2019 Individual Platinum Benefit Summary
- 2019 Individual Silver Benefit Summary
- 2019 Individual Silver Value Benefit Summary
- 2019 Individual Standard Plan Comparison and Rates
- 2019 Individual Non-Standard and Catastrophic Plan Comparison and Rates
- 2019 Hospital Brochure
- 2017 Q4 Rate Sheet Small Group Off-Exchange
- 2018 Individual Non-Standard and Catastrophic Plan Rates
- 2018 Individual Rate Sheet (Age 29, Child Only)
- 2018 Individual Standard Plan Rates
- 2018 Q3 Rate Sheet Small Group Off-Exchange
- 2018 Q4 Rate Sheet Small Group Off-Exchange
- Q1 2019 Small Group Rate Sheet - NYC
- Q1 2019 Small Group Rate Sheet - Long Island
- Q1 2019 Small Group Rate Sheet - Mid-Hudson
- Q1 2019 Small Group Rate Sheet - Albany
- 2019 Individual Rates
- 2019 Individual Standard Plan Comparison and Rates
- 2019 Individual Non-Standard and Catastrophic Plan Comparison and Rates
- 2018 Hospital List
- 2018 Individual Backup Bronze Plan
- 2018 Individual Backup Gold Plan
- 2018 Individual Backup Silver Plan
- 2018 Individual Classic Bronze Plan
- 2018 Individual Classic Gold Plan
- 2018 Individual Classic Platinum Plan
- 2018 Individual Classic Silver Plan
- 2018 Individual Simple Bronze Plan
- 2018 Individual Simple Gold Plan
- 2018 Individual Simple Secure Plan
- 2018 Individual Simple Silver Plan
- 2018 Small Group Backup Bronze Plan Description
- 2018 Small Group Backup Gold Plan Description
- 2018 Small Group Backup Silver 3000 Plan Description
- 2018 Small Group Backup Silver 5000 Plan Description
- 2018 Small Group Classic Bronze Plan Description
- 2018 Small Group Classic Gold 0 Plan Description
- 2018 Small Group Classic Gold 1000 Plan Description
- 2018 Small Group Classic Gold 2000 Plan Description
- 2018 Small Group Classic Gold 500 Plan Description
- 2018 Small Group Classic Platinum 2000 Plan Description
- 2018 Small Group Classic Platinum 3000 Coinsurance Plan Description
- 2018 Small Group Classic Platinum 3000 Copay Plan Description
- 2018 Small Group Classic Silver 3000 Plan Description
- 2018 Small Group Classic Silver 3500 Plan Description
- 2018 Small Group Classic Silver 4000 Plan Description
- 2018 Small Group Classic Silver 4500 Plan Description
- 2018 Small Group Simple Bronze Plan Description
- 2018 Small Group Simple Gold Plan Description
- 2018 Small Group Simple Silver Plan Description
- 2019 Q1 Small Group Plan Overview and Rates
- 2019 New York Hospital List
- 2019 Individual Plans and Rates
Dental Insurance
- 5-99 Utilization Guide by Industry
- Ameritas $1000 plan w/PED for groups of 2-4
- Ameritas $1000 plan w/PED for groups of 5-99 (High Utilization)
- Ameritas $1000 plan w/PED for groups of 5-99 (Low Utilization)
- Individual Dental Product Brochure
- NY Specials Plan Brochure
- NYSBG 599-1 Plan Information and Rates
- NYSBG 599-2 Plan Information and Rates
- Benefit Description - BASIC
- Benefit Description - ENHANCED
- Benefit Description - HIGH
- Benefit Description - LOW
- Benefit Description - MEDIUM
- Benefit Description - PREMIER
- Benefit Description - Preventive Incentive Rider - BASIC
- Benefit Description - Preventive Incentive Rider - HIGH
- Benefit Description - Preventive Incentive Rider - LOW
- Benefit Description - Preventive Incentive Rider - MEDIUM
- Benefit Description - Vision Plan - Davis Vision (Included with Dental Plan)
- Fast Facts
- Online Services for Plan Subscribers
- Provider Listing - Downstate NY (Use of On-Line Provider Link Recommended)
- Provider Listing - Find a Dentist On-line (Instructions)
- Provider Listing - Upstate NY Region (Use of On-Line Provider Link Recommended)
- "Provider Listing - Find a Dentist On-line (Instructions)" has no version set!
Vision Insurance
Hospital Indemnity
Life Insurance
Disability Insurance
- APPLICATION FORMATTING - PAGE ORDER - ALL POLICIES
- Application Instructions - Business Overhead Expense
- Application Instructions and Checklist - All Policies
- Enrollment Application - Agreement - UN 2550 AG 2-12 NY
- Enrollment Application - Authorization - UN 2550 AU 2-12 NY
- Enrollment Application - Conditional Receipt - UN 2550 CR 2-12 NY
- Enrollment Application - Health Questionnaire - UN 2550 HQ 2-12 NY
- Enrollment Application - Lifestyle Questionnaire - UN 2550 LQ 2-12 NY
- Enrollment Application - Notice of Insurance Information Practices - UN 2550 NI 2-12 NY
- Enrollment Application - Occupation and Financial Information - UN 2550 DI FI 10-11 NY
- Enrollment Application - Personal Information - UN 2550 PI 10-11 NY
- Enrollment Application - Policy Details - UN 2550 DI 10-11 NY
- Enrollment Application - Producers Statement - UN 2550 PS 10-11 NY
- Enrollment Application - Why Second Authorization - UN 1447 NY
