Benefit Solutions - Health Insurance Wholesalers

Network Benefit Solutions Licensed in NY

ONLINE FORMS Forms are available in Adobe Acrobat (.PDF) file formats. If you do not have Acrobat, click the logo on the right to download.

New Jersey Forms	Jump to New York Forms

AmeriHealth Insurance Co. of NJ	Go to AmeriHealth forms download page Broker of Record Letter

Cigna (NJ)	Submission Requirements Compensation Acknowledgment Form (CAF-4) Customer Acknowledgment Form (CAF-1) Small Employer Application Employer Certification Late Paperwork Form Employee Enrollment & Change Form Waiver Of Coverage Broker of Record Letter

Horizon BCBSNJ	*Individual Health* Application for Individual Health Benefits Plan Broker of Record Letter Group Health Employee Application & Change Form Small Employer Application Employer Certification Employment Verification Spouse's Statement Family Profile Waiver Of Coverage Insurance Claim Broker of Record Letter Automatic Pay Plan Application Authorization for Disclosure of Protected Health Information Caremark Mail Order Form Group Dental Dental Small Employer Application Dental Employee Application & Change Form Dental Service Report

United Healthcare, Inc. (NJ)	Sold Case Summary & Checklist Small Employer Application Employer Certification Late Paperwork Form Employee Application & Change Form Waiver Of Coverage Case Appointment Form Broker of Record Letter

New York Forms	Jump to New Jersey Forms

Cigna (NY)	Compensation Acknowledgment Customer Acknowledgment Employer Application Employer Certification Enrollment & Change Form Late Paperwork Form Submission Requirements Trust Agreement Broker of Record Letter

Horizon Healthcare (NY)	New York Small Group Sold Case Checklist Small Employer Group Application Instructions Small Employer Group Application Late Paperwork Form Spouse's Business Statement Employee Enrollment Application Enrollment Change/Deletion Form Waiver of Coverage Form Broker of Record Letter Broker of Record Letter (Individual)

United Healthcare, Inc. (NY)	Employer Application Group Enrollment Request For Appointment Select HMO Form SelectPlus HMO+ Form Tax Documentation Verification Broker of Record Letter