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This document notifies recipients about a proposed premium rate adjustment for the United Healthy New York small group product and provides information on how to submit comments or requests for additional
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How to fill out Healthy New York Small?

01
Obtain the Healthy New York Small application form from the official website or by contacting the New York State Department of Health.
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Carefully read through the instructions provided with the application form to ensure you understand the requirements and eligibility criteria.
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Fill in the required personal information, such as your name, address, date of birth, and contact details.
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Provide information about your current health insurance coverage, including the name of your insurance company and policy number.
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Sign and date the application form where indicated.
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Submit the completed application and any supporting documents to the address listed on the form or as instructed by the New York State Department of Health.

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Individuals who currently do not have health insurance coverage and meet the eligibility requirements set by the New York State Department of Health.
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