Enrollment

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​Open Enrollment is held annually from November 1 through 30,

for an effective date of January 1. 

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All new small business or individual/sole proprietor enrollment applications must include either an NYS45 payroll document, a Schedule C, or a W4 issued to a new hire proving employment by the business.

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For questions related to plans, enrollment or forms, please call 518.431.1419 or email our enrollment team.

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Enrollment Forms

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CDPHP

• Enrollment/Change Application - Can be completed online and printed.

• Pediatric Dental Waiver

• *New Groups* -Employer must complete these two forms:  Employer Group Size Attestation   Employer Group Application

 

MVP HEALTHCARE

• Individual or Sole Proprietor Medical Plan Application

• Individual or Sole Proprietor Dental Application

• Enrollment/Change Application - Small Business

• Small Business Dental Application

• Dental Waiver for small groups

• *New Groups* -Employer must complete this packet and attach to your NYS45:    New SubGroup Packet   

 

EMPIRE BLUE VISION PLAN  -  Enrollment Application for Vision plan

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GUARDIAN DENTAL - Enrollment/Change Application

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HIGHMARK BLUESHIELD OF NENY

• Enrollment Application

• New Employer Group Enrollment Form

 

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Billing and Payment

 

Premiums for health insurance are invoiced on a monthly basis through Business Services Corporation dba Benefit Choices. ​Bills are mailed mid-month covering the following month; payment is due on the first of the month. (i.e., February premium invoice is mailed mid-January and is due February 1.) Payments not received in a timely fashion incur a late fee of $25.  Coverage may be terminated if payments are more than 30 days past due.

 

We offer two payment methods:  

• A Check can be mailed using the envelope provided with your invoice. All payments should be mailed to Benefit Choices, PO Box 10145, Albany, NY 12201.

• Electronic Payment - By completing our Authorization Form, you can elect to have your monthly premium electronically deducted on the first business day of each month.

 

For billing or payment questions, or to obtain a copy of your invoice, please call 518.431.1419 and ask for Trish Smith, or use the

email form below.

 

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