Health Insurance Forms and Links

CEWW Health Insurance

Empire Blue Cross
Empire Blue Cross Customer Service Representative (email [email protected] or call (518)419-3161 Monday Thru Friday 8:30 a.m. to 5:00 p.m.)
Empire Blue Cross Claim Form
Empire Blue Cross Platinum Plan 1 and 2 Benefit Descriptions
Empire Blue Cross Bronze Plan Benefit Descriptions

Ingenio Mail Order (Call 1-833-203-1739 or Fax 1-800-378-0323)
Ingenio Claim Form

LiveHealth Online (telemedicine) - This benefit is covered at 100% for Plan 2 members and a cost of $11.80 for Plan 1 members. When you log in, the system references the cost of $59, however, once you elect a provider and go through the process, your actual cost will show.
LiveHealth Member Registration / LHO._Covid-19.pdf

CHIP Notice
Dept. of Labor ACA Compliance Notices
Drug Evaluation Request Form