Oxford has released a new NYSG Employer Application and Employee Enrollment Form.

Posted on November 14, 2023

Below are links to these forms with instructions from Oxford. 

Oxford NYSG Employer Application OHI

• The new employer application is now only 4 pages! With the new version, employers no longer have to complete the Product and Plan Design Section
• It is very important that all new business submissions include signed medical rates. Without signed medical rates, Oxford will not process your new business submissions. The signed medical rates will validate which plan designs and rates have sold
• The new employer application should be utilized for all new business submissions beginning with 1/1/2024 effective dates
  • The previous version of the employer application will no longer be accepted beginning with 1/1/2024 effective dates

Oxford NYSG Employee Enrollment Form OHI

• The new enrollment form is now a combined member enrollment and waiver form, which means this form should be utilized for all enrolling and waiving employees
  • Please note if employees are waiving medical coverage, they will need to complete Sections A & B
• The enrollment form can be utilized effective immediately
  • The previous version of the Member Enrollment and Waiver Forms will no longer be accepted beginning 1/1/2024