Forms

General Employer Tools & Resources

• Employer Forms

  General

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

  New York

  • NY Small Group Silver 4 Application (PDF)
  • NY Vision Plan Selection Form (PDF)

  Vermont

  • VT Vision Plan Selection Form (PDF)

  
  

• Large Group Information

  
  

• Small Group Information

  
  

Creditable Coverage

• 2023 Creditable Coverage Materials

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

  
  

• 2022 Creditable Coverage Materials

  
  

• 2021 Creditable Coverage Materials

  
  

• 2020 Creditable Coverage Materials

  
  

Medicare Employer Tools & Resources

• Medicare Group Information