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 Large Group Size Attestation
- Employer Large Group Size Attestation (Fillable)
- Grandfathered Plan Status Certification
- Grandfathered Plan Status Certification (Fillable)
- Independent Contractor Attestation
- Independent Contractor Attestation (Fillable)
- Large Group HMO Attestation
- Large Group HMO Attestation (Fillable)
- MVP Core Analytics
New York and Vermont Forms
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- 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)
- Independent Contractor Attestation
- Independent Contractor Attestation (Fillable)
New York Small Group
- Enrollment/Change Form—New York Small Group HMO (PDF)
- Enrollment/Change Form—New York Small Group HMO (PDF)—Spanish
- Enrollment/Change Form—New York Small Group EPO/PPO (PDF)
- Enrollment/Change Form—New York Small Group EPO/PPO (PDF)—Spanish
- New York Small Group Application HMO (Fillable)
- New York Small Group Application EPO/PPO (Fillable)
Healthy New York
- Enrollment/Change Form—Healthy New York (PDF)
- Enrollment/Change Form—Healthy New York (PDF)—Spanish
- Healthy New York Small Group Application (Fillable)
- Healthy New York Small Group Recertification Form
- Healthy New York Small Group Recertification Form (Fillable)
Vermont Small Group
- 2025 Vermont Small Group Plan Selection Form
- 2025 Vermont Small Group Plan Selection Form (Fillable)
- 2024 Vermont Small Group Plan Selection Form
- 2024 Vermont Small Group Plan Selection Form (Fillable)
- Enrollment/Change Form Vermont Group
- Vermont Small Group Application Form (Fillable)
- Vermont Small Group Recertification Form
- Vermont Small Group Recertification Form (Fillable)
Creditable Coverage Forms
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