Downloadable Forms

For your convenience, we have developed a downloadable insurance forms section. Please feel free to check back here for frequent form updates.

Ameriflex - Uber Partnership

Ameriflex is excited to partner with Uber to bring commuters a new program that combines
the convenience and comfort of Uber with the money-saving advantages of an Ameriflex
commuter benefits plan.
UberPOOL lets you to share your ride (and split the cost!) with other Uber riders. You'll know
your flat-rate fare before you even leave, and best of all, now you can pay for your ride
using pre-tax funds from your Ameriflex Commuter Reimbursement Account (CRA). It's a quick
and comfortable alternative to mass transit and public transportation!
Commute to work in 3 easy steps:
1. Download the Uber App on your mobile device.
2. Enter your MyAmeriflex Card information as a payment source.
3. Request a ride, and rest easy with the uberPOOL fare guarantee.
Enjoy your new and more affordable commute to work with uberPOOL!
Visit for more information about uberPOOL.

Aetna 2017 Small Group Discontinued Plans

All   Brokers Placing NY Business:
  Aetna discontinuing 2017   Small Group Platinum Plans

Aetna News -   September 30, 2016
  Aetna regularly assesses our product and plan options to ensure that we   provide a competitive offering. By continually assessing and refining our   product offering, we are able to focus our energy and investments on the   products that our customers are most interested in.
  Effective January 1, 2017, Aetna will discontinue our five platinum small   group plans offered in New York. This will effect small groups cases that   renew on or after January 1, 2017.
  Those plans are shown below: 
  •    NY Platinum NYC Community PlanSM $20
  •    NY Platinum NYC Community PlanSM $20 DEP30
  •    NY Platinum NYC Community PlanSM $30
  •    NY Platinum NYC Community PlanSM $30 DEP30
  •    NY Platinum OAEPO $25
  •    NY Platinum OAEPO $25 DEP30
  Despite these changes to our small group offering, Aetna will continue to   offer other competitive small group plans in New York.

Please contact your PGM Sales Rep for further information.

Empire - Small Group Market


  It's time for Empire BlueCross BlueShield and the Small Group market


  As you may have already heard, Empire BlueCross BlueShield is re-entering the small group market. Built on the foundation of responsible pricing, Empire has dedicated a tremendous amount of time and resources to ensure success over the long-term, with a commitment to the GA, the broker and your clients.
  With strong rate approval comes strong compensation. Empire will pay 5% of premium on EPO/PPO sales and renewals in 2017. 4% of this is a base amount which Empire envisions continuing to pay into 2018. HMO sales will pay a 2% of premium commission in 2017.
  Premiums are consistent across the NYC, Long Island, and Mid-Hudson rating areas. The Empire 2017 Small Group Product Guide includes some of the higher-level benefit and plan details. SBC and SOB documents will be available in early October.
CLICK HERE for the Downstate Q1 2017 rates
  -  CLICK HERE for the Empire 2017 Small Group Product Guide
  Benefits and rates will be available for quoting in HealthConnect by early October, with Empire accepting new business through their online SALES portal (their new Small Group quoting and enrollment system), on October 17
  With 28 new plans, 3 provider networks and an enormous investment in technology/efficiency, Empire is properly equipped to re-enter the Small Group market, and support the broker community the right way.
  Empire will also be making available a new library of materials to support your client to make selling these new products easier. It includes selling   tools, plan and network education, as well as employee on-boarding materials. 
  We look forward to working together with Empire as they re-enter the small group market.


New York City Amends Mass Transit Benefit Rules

New York City Amends Mass Transit Benefit Rules

New York City (NYC) enacted Local Law 2014/053 to require employers with 20 or more full-time employees in the city of New York to offer their employers the use of pre-tax earnings to purchase qualified transportation benefits. See our Compliance Alert New York City Transit Ordinance Guarantees Pre-Tax Transit Benefits.

Local Law 2014/053, recently amended by the addition of a new chapter 8, adopts rules clarifying the law and provides the following guidance.

  • Clarifies the definition of full-time employee;
  • Requires that employers maintain certain documentation demonstrating compliance with the law;
  • Establishes how business size is calculated to determine whether a business is covered under the law;
  • Clarifies how the law applies to temporary help firms;
  • Permits employers to offer certain transportation benefits at the employers’ expense in lieu of offering employees the opportunity to use pre-tax earnings to purchase qualified transportation fringe benefits.

Recordkeeping Requirements
The guidance also clarifies that the employer must retain records for two years sufficient to demonstrate that:

  1. Each eligible employee was offered the opportunity to purchase transit benefits on a pretax basis, and either accepted or declined the offer, or 
  2. Employers provide, at their own expense, a transit pass or similar form of payment for transportation on public or privately owned mass transit or in a commuter highway vehicle at the maximum pre-tax level permitted under federal law for transit expenses.

If employers satisfy the requirements using the method outlined in #2 above, they do not have to produce all the other paperwork to demonstrate compliance with the law.

To assist with the record keeping requirement and provide information about the plan, NYC makes available an employer compliance form to gather records of employees’ acceptance or refusal of participation in the commuter benefits program.

Under the amended law, employers will be assessed $250 for each of the first, subsequent and any recidivist (new) violations. To avoid penalties, employers must demonstrate they offered their full-time employees the opportunity to purchase qualified commuting expenses with pre-tax dollars. 

The monthly IRS limit for qualified transportation fringe benefits is $255 in 2016 for transit passes and vanpooling expenses, combined, or $20 for qualified bicycle expenses. The limits are indexed and may increase in 2017. The monthly IRS limit for qualified parking expenses is $255 in 2016, and is also an indexed amount, which may increase in 2017. Parking benefits are not required by local law 2014/053; however, qualified parking may be used in addition to the other benefits.

The ordinance was effective January 1, 2016 for covered employers; however, they were not subject to civil penalties for violations that occurred before July 1, 2016. Covered employers need to review the NYC transit program to ensure compliance with all NYC transit requirements.