New York State Business Group

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Forms and Applications

GHI BROKER RATE PACKAGE - 3rd Quarter 2008

GHI BROKER RATE PACKAGE - 2nd Quarter 2008

GHI Renewal Portal

Coordination of Benefits Form

Coordination of Medicare Benefits

Dependent Student Certification Form

Employee Enrollment Application

EPO Benefit Highlights

EPO Share Benefit Highlights

EPO/EPO Share Plan Selection Form

Flex Coordinated Care Network III Participating Chains

Flex Select Hospital List

GHI Pharmacy Member Handbook

Health Insurance Claim Form

Late Paperwork Form

Letter of Certification

New Case Submission Form

PPO Benefit Highlights

PPO Plan Selection Form

PPO Share Benefit Highlights

PPO Share Plan Selection Form

Rx Direct Reimbursement Claim Form

2008 Rx Formulary (drug alpha)

2008 Rx Select Formulary

Request for Plan Change Sole Proprietors

Small Business Advanatage Plan Selection/Highlights

Small Employer Group Application Form

Domestic Partnership Declaration

Cohabitation Declaration

Underwriting Guidelines

High Deductible Health Plan / HSA

PPO Plan Selection Form

EPO Plan Selection Form

Group Setup Application

HSA Guide Small Group

HSA Guide Large Group

HSA Information Brochure

HSA Question and Answer Sheet

HSA PPO Sales Sheet

HSA EPO Sales Sheet

Small Group Application Form

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