Atlantis Health Plan - Employers

Products Healthy New York Benefit Summaries Riders Rx Plans Forms Employer Information Eligibility Requirements Waiting Period Administrator Handbook Contact Us Clinical Review Criteria

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.

Notice of Enrollment Period and Waiver Form Employer Member Enrollment & Physician selection Application

Health Insurance Claim Form (HCFA 1500) Group Agreement Form

Credit Card Authorization Employer Update/Termination/Deletion Form

Age 29 Enrollment Form - Group Employees Age 29 Enrollment Form - Direct Pay.pdf