The new Healthy New York – New Group Application and Recertification Form is now available for brokers and small groups.
The New Group Application should only be used when a small group is applying for a standalone Healthy New York plan, or when applying for Healthy New York along with another commercial plan.
The New Group Application can be found online at New Group Paperwork | Brokers | Excellus BlueCross BlueShield.
The new form will be required for all new Healthy New York business use as of April 1, 2025, instead of the DFS HNY New group application. If a group does use the DFS HNY New group application before the cutoff date, please ensure they also complete the Healthy NY Eligibility Policy form.
The Recertification Form can be found online at Renewal Group Paperwork | Brokers | Excellus BlueCross BlueShield.
Please complete the recertification form in its entirety. It is important that the form is fully completed to be able to process recertifications in a timely manner.
If you have any questions on the Healthy New York – New Group Application or Recertification Form, please contact your account manager or dedicated underwriter.
