Medical Insurance Forms
To download these forms to your computer, right-click on the link and choose "Save Target As." Forms last updated May 24, 2009.
General Documents
COBRA - Sample LetterCOBRA - Sample Follow Up Letter
COBRA - Termination Letter
COBRA - Notice of Qualifying Event
COBRA - Notice of Unavailability
COBRA - General Notice
HIPAA Certificate Form
Empire Blue
Small Group ApplicationEnrollment/Change Form
Enrollment/Change Form in Spanish
Small Group Recredentialing Form
Group Contract for HMO or Direct HMO
Student Questionnaire
Renewal Worksheet
UnitedHealth/Oxford
Small Group ApplicationContact/Address/Name Change
Member Enrollment Form
Addition/Termination Changes
COBRA Election Form
LIA Health Alliance
Enrollment/Change FormHIP Claim Form
GHI Claim Form
