Easy Choice

Forms

To download a form, just click on a link below. You will need Adobe Acrobat Reader to open all files below.

Selling Agent Forms

Broker Enrollment Contract

Policy Broker of Record Letter (BOR)

Broker and GA Direct Deposit Authorization

Submitting for a Group

Case Installation Sales Regulation

Group Agreement Form

Notice of Enrollment Period and Waiver Period Form

Previous Insurance Coverage Form

Employer Member Enrollment & Physician Selection Application

Easy Choice Rewards Program Application

Healthy New York Individual Application

Healthy New York Group Application

Credit Card Authorization Form