Get New York Small Group Annual Certification Form

Filling out the New York Small Group Annual Certification Form online can enhance your efficiency and accuracy in managing employee health coverage. This guide provides a comprehensive overview of the form's components and step-by-step instructions to ensure a seamless experience.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your employer name and group number in the designated fields. It is essential to provide accurate information to ensure proper processing.
3. Fill out the address fields, including street address, city, state, and ZIP code, making sure all details are complete and correct.
4. Answer the certification questions accurately. Start with the total number of employees, including seasonal and part-time workers from the previous calendar year.
5. Indicate the number of eligible employees who work 20 or more hours per week. Ensure you exclude any individuals compensated via IRS 1099 Forms.
6. For questions regarding eligible employees offered Oxford coverage, specify both in-area and out-of-area counts for those working eligible hours.
7. Inquire about any eligible retired former employees, if applicable, and report the number accordingly.
8. Complete questions regarding enrolling employees, those waiving coverage, and the group’s situation regarding COBRA requirements.
9. Confirm if the group is offering other group health insurance coverage and provide details such as the name of the other carrier and effective dates if applicable.
10. Complete the required tax documents section to support compliance with participation requirements. Include any additional documents as specified.
11. Review your entries for accuracy and completeness. Once all information is entered, you can save changes, download, print, or share the completed form as needed.

Complete your New York Small Group Annual Certification Form online today for a streamlined process.