Enrollment Requirements

Note: Rates are subject to change by carrier.

In order to enroll in any of the health plans (medical and/or dental) offered, there are certain underwriting guidelines that have been established and are required within New York state for each insurance carrier.

A certificate upon initial enrollment and an annual re-certification for each company enrolled, in one or more of the health plans, is needed. In order to be certified or re-certified, one piece of current documentation listed below, executed with a signature, is required.

In addition, completed and signed applications for each enrollee in a health plan must be initially sent with this information. Once the company has been enrolled, additional employee enrollments may be forwarded in accordance with the company's enrollment procedures and with fulfillment of the waiting periods.

Below is a list of the materials that must accompany a company's application for enrollment. Please be sure that all materials are complete and signed. The company must verify that any person enrolling in a plan has completed the appropriate enrollment forms and has fulfilled the eligibility and waiting period requirements.

Contact the administrator at (518) 431-1419 and select option 1 to verify all documentation required for each specific health insurance carrier.

Documentation (one of the following)

CORPORATION

NYS-45 or NYS-45 ATT Tax Form (quarterly wage withholding)
Form 1120-S US Corporation Income Tax Form for S Corporation
CT-4-S NY S Corporation Franchise Tax Return Form
Form 1065 with Schedule K-1 for Partnership
Schedule E (Sub-chapter S Corp)
Schedule F - Profit & Loss from Farming
Schedule C
Schedule K-1, Form 851, Form 990, Form 1120
Form 1099
Form 1120S (Corp S Income Tax Return)
Schedule CES
Form 1099 (not applicable for GHI or Empire Blue Cross)
Form 8829 Expenses for Business Use of Home

SOLE PROPRIETOR

Article of Incorporation
Schedule SE (signed)
SS-4 Certificate of Incorporation; payroll listing; CPA letter
Completed tax return for most recent year with W2s
Attorney/CPA Letter of Certification for spouse as eligible employee
CPA Letter of Certification for sole proprietor hiring eligible employees

Additional Information

Current tax documentation will be defined as the prior year's fourth quarter or third quarter filing, or a more recent filing, if available.
Must have a physical street address for the business (PO box not acceptable).
Tax documentation must substantiate full-time employment (20 hours or more a week).
Letter of Certification is acceptable, but only for the first 90 days (follow-up documentation will be required).
W-4 form is sufficient for new hires only if not dated in excess of 90 days.

Blue Shield of Northeastern New York requires a completed company application as well as completed individual applications from eligible employees (and eligible dependents, if enrolling).

Empire Blue Cross requires a completed Healthy NY application meeting all requirements before acceptance into the Healthy NY program. Applicants must also meet salary requirements for eligibility.

Contact the administrator at (518) 431-1419 and select option 1 for further information.

All other health insurance carriers require their specific completed and signed individual application.

Businesses in operation less than one year require the following documents: cancelled business check and business bank statement; certificate of doing business or appropriate tax documentation.

Processing Fees

Medical plans have a $20 per application processing fee. Dental plans have a $10 per application processing fee. Processing fees will be billed with the first invoice.

Waiting Periods

For additional information on waiting periods, call (518) 431-1419 and select option 1.

New Albany-Colonie Regional Chamber Member Companies/New Employees

For new Albany-Colonie Regional Chamber member companies, completed and signed applications must be received within the initial 30 days (corporations) or 60 days (sole proprietors) of Chamber membership approval. Applications must be received no later than the 10th of the prior month for an effective date of the first day of the month following receipt of all completed and signed forms and other required information.

For new employees to Albany-Colonie Regional Chamber member companies, completed and signed applications must be received no later than the 10th of the prior month for an effective date of the first day of the month following receipt of the completed and signed forms and other required information.