Below are links to Healthy NY application forms.  Each application is in Adobe PDF format (*.pdf), which requires the Adobe Acrobat Reader (version 7.0 or above) to view and print.  Applications need to be completed and mailed to the participating health plan of your choice. For a list of premium rates and the names and addresses of health plans in your area that offer Healthy NY, select the link HMOs and Rates by County.

• Individuals and Sole Proprietors
• Small Employers