Employer Forms

Employer Forms

Paperwork Made Easy

For your convenience, all the forms you need for your group can easily be downloaded to your computer.

If you have any questions or need additional assistance, please contact CDPHP Employer Services at 1-866-258-1785.

• Employer Group Applications
• Employer Group Application - HMO
• Employer Group Application - EPO, PPO, HDPPO
• Employer Group Application - Fox First
• Employer Group Application - Hospital Only
• Employer Group Application - ASO
• Employer Group Application - Dental
• Employer Group Application - Group Medicare
• Employer Group Application - Healthy New York
• Employer Group Application Supplement - Healthy New York

• Employee (Member) Applications & Change Forms
• Employee Application / Change Form - HMO & POS
• Employee Application / Change Form - EPO, PPO, HDPPO
• Employee Application / Change Form - Fox First
• Employee Application / Change Form - Hospital Only
• Employee Application / Change Form - ASO
• Employee Application / Change Form - Dental
• Employee Application / Change Form - Healthy New York
• Employee & Retiree Application / Change Form - Group Medicare

• General Forms
• Employer Access Forms for Online Health Administrator
• Employers - How Do I Get Access to Online Health Administrator?
• Authorization to Release Health Information
• Handicap Waiver Request
• Pre-Existing Condition Questionnaire - CDPHP UBI
• Prescription Reimbursement - Foreign Claim Form
• Prescription Reimbursement - Standard Claim Form
• Prior Authorization Requirements - CDPHP UBI
• Student Verification Form

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