Forms

• Affidavit of Domestic Partnership - Group Legally establish a domestic partnership for the purposes of enrolling your partner on your health insurance plan.
• Direct Bill COBRA Paperwork COBRA and New York Continuation of Benefits billing.
• Disability Certification Form Certification of an unmarried child's disability and eligibility for continued coverage.
• Student Dependent Verification Form This form must be completed to verify that your dependent age 19 or over is a full-time student at an accredited college or university.
• Termination Request Form All subscriber terminations must be written on this form to be processed properly.