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Forms

General Employer Tools & Resources

Employer Forms
- 2020 NY Small Group Silver 4 Application (PDF)
- 2020 MVP Spending Account Application (PDF)
Large Group Information
- New York Large Group Billing & Contact Form (PDF)
- Enrollment/Change Form—New York Large Group (PDF)
- Enrollment/Change Form—Vermont Group Plans (PDF)
- MVP Core Analytics (PDF)
Small Group Information
- New York Small Group Application HMO (PDF)
- Enrollment/Change Form—New York Small Group HMO (PDF)
- New York Small Group Application EPO/PPO (PDF)
- Enrollment/Change Form—New York Small Group EPO/PPO (PDF)
- Enrollment/Change Form—Vermont Group Plans (PDF)
- Vermont Group Plan Enrollment Form (PDF)
- New York Small Group Recertification Form (PDF)
- Vermont Small Group Recertification Form (PDF)
- Healthy New York Small Group Application (PDF)
- Healthy New York Recertification Form (PDF)

Creditable Coverage

Medicare Employer Tools & Resources

Medicare Group Information
- Medicare Advantage Employer Handbook (PDF)
- Medicare Group Comprehensive Part D Formulary (PDF)
- Medicare Actively Employed Information Form (PDF)
- Medicare Employer Group Enrollment Form (PDF)