Required Informaiton


  • New Group ApplicationOpen a PDF
  • Signed rate sheets and benefit selections
  • Enrollment Forms
  • NYS-45 or other state equivalents from the most recently filed report
  • For a new employee, a current payroll report and W-4’s
  • Business check for the first month’s premium


If Applicable

Additional Documents

Need Help?

Our expert advisors can help you find plans to meet your company's needs: 

Rochester: (585) 339-7806 

CNY/Utica: (607) 259-9274 
Includes Oneonta, Plattsburgh, and Watertown 

Binghamton: 1-877-208-5264 
Susanna Smith: (607) 259-9274 

Megan Schmidt: (607) 738-8962 
Derek Stevens: (607) 425-4902 
Susanna Smith: (607) 259-9274