Access Printable Forms

Please choose from the list below to download an adobe acrobat pdf file. If you do not have acrobat reader you can download it here or click the acrobat reader logo below the list to download the free program.

Selling Agent Forms

	Broker Enrollment Contract
	Policy Broker of Record Letter (BOR)
	Broker and GA Direct Deposit Authorization

Submitting for a Group

	Case Installation Sales Regulation
	Group Agreement Form
	Notice of Enrollment Period and Waiver Period Form
	Previous Insurance Coverage Form
	Health Insurance Claim Form (HCFA 1500)
	Employer Member Enrollment & Physician Selection Application
	Atlantis Rewards Program Application
	Healthy New York Individual Application
	Healthy New York Group Application
	Credit Card Authorization Form