Forms & Downloads

Below you will find forms that you may need. To submit a form or supply supporting documents, follow the instructions specific to each form.

• EmblemHealth Large Employer Group Application.
  Complete this application before enrolling a large employer group with EmblemHealth.
• EmblemHealth Small Employer Group Application.
  Complete this application before enrolling a small employer group with EmblemHealth.
• Transaction Form for Group Accounts
  This form should be used for enrolling, terminating or changing the status of a subscriber.
• Health Benefits Waiver Form
  This form should be completed by an employee who is declining enrollment in the plan.
• Small Group Handbook (2-50) | Large Group Handbook (50+)
  Our group handbooks provide clear and direct answers to the most commonly asked questions about benefits administration. For complex issues, please call EmblemHealth Account Services at 1-866-614-6040, Monday through Friday, from 9 am to 5 pm.

NOTE: The forms on this page are available as Adobe® PDF files. You will need Adobe Reader®, a free program from Adobe, to download and print the forms. Click here to get Adobe Reader now. Follow Adobe's instructions for download and installation. Print out the appropriate form and mail it to the address listed on the form.

Effective September 23, 2010, federal health reform may require changes to your coverage, depending on your plan. Get more information at www.emblemhealthreform.com.