Employer Forms

• MVP Spending Account Application
• Health Benefits Administrator and Plan Sponsor Designation

New York and Vermont Forms 

• NY Small Group Silver 4 Application
  
• NY Vision Plan Selection Form
  
• VT Vision Plan Selection Form

• MVP Core Analytics
• Employer Large Group Size Attestation
  
• Employer Large Group Size Attestation (Fillable)
  
• Large Group HMO Attestation
• Large Group HMO Attestation (Fillable)

New York and Vermont Forms

• New York Large Group Billing & Contact Form
  
• Enrollment/Change Form — New York Large Group
  
• Enrollment/Change Form — Vermont Group Plans

• 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

• Vermont Small Group Application Form
• Vermont Small Group Recertification Form
• Vermont Small Group Recertification Form (Fillable)
  
• Enrollment/Change Form — Vermont Group Plan
• 2022 Vermont Small Group Plan Selection Form
• 2023 Vermont Small Group Plan Selection Form
   

• 2023 Creditable Coverage Determinations
  
• 2023 Creditable Coverage Template for Employers
  
• 2023 Non-Creditable Coverage Template for Employers
  
• 2023 Overview of Creditable Coverage Information

• 2022 Creditable Coverage Determinations
  
• 2022 Creditable Coverage Template Letter for Employers
  
• 2022 Non-Creditable Coverage Template Letter for Employers
  
• 2022 Overview of Creditable Coverage Information

• Creditable Coverage Determinations 2021
  
• Creditable Coverage Template Letter for Employers 2021
  
• Non-Creditable Coverage Template Letter for Employers 2021
• Overview of Creditable Coverage Information 2021