New Group Paperwork
Manage Prospects and New Groups
Access Manage Prospects & New Groups to quote, sell, and manage new Small Group prospects:
- Instant access to create and download Small Group quotes
- Access Benefit Summary and Summary of Benefits & Coverage (SBC) documents
- Electronically complete the New Group Application and upload any required documentation
- Track the status of your prospects and new group submissions
View our helpful introduction to Small Group quoting guideOpen a PDF to get started.
Required paperwork
Commercial
Healthy NY
Medicare Group
- Medicare Annual Group Information FormOpen a PDF
- Signed rate sheet
- Enrollment applications
- Medicare Eligibility FormOpen a PDF
If applicable
- Dependent Certification (Student Verification) FormOpen a PDF
- Adult Disabled Dependent FormOpen a PDF
- Young Adult Option Certification (Dependent Age 29) FormOpen a PDF
- Administrator Electronic and Web Enrollment AgreementOpen a PDF
- Community Rated Subgroup ApplicationOpen a PDF
Additional documents
Required paperwork
Commercial
- New Group ApplicationOpen a PDF
- Signed rate sheets and benefit selections
- Enrollment applications
- COBRA Administrative AgreementOpen a PDF
Medicare Group
- Medicare Annual Group Information FormOpen a PDF
- Medicare signed rate sheet
- Medicare enrollment applications
- Medicare Eligibility FormOpen a PDF
If applicable
- Name of FSA Administrator
- Certificate of Coverage Run List (Previous Carrier)
- Stop Loss Paperwork
- STM Grids for New Products
- Dependent Certification (Student Verification) FormOpen a PDF
- Adult Disabled Dependent FormOpen a PDF
- Young Adult Option Certification (Dependent Age 29) FormOpen a PDF
