Insurance Enrollment

To better assist you in obtaining the best coverage for you and your family through the New York State of Health marketplace, please be prepared to have the following information about each member in your household (if appropriate):

1. Name, Social Security Number and Date of Birth (for all household members)
2. Tax filing status (Do you file taxes? If so, do you file them alone or with your spouse? How many dependents you claim?)
3. The name and address of your current employer

Income information that may be helpful to bring:

• Last 4 weeks of pay stubs along with name and address of your employer(s)
• Last year’s tax returns, including w-2s and all schedules, for everyone in the household, or if you are self-employed, a record of the last three months of earning and expenses.
• Income Documentation for other types of income, e.g. Social Security, Unemployment Benefits
• Information about any other health insurance you or other family members may have or offered by your employer. (Please have employer(s) complete attached form Employer Coverage Tool if applicable).
• Insurance cards or copy of front and back of cards
• If applicable, immigration (Alien) number for immigrant family members. It is often easier to process your application if you are able to bring copies of all immigration correspondence to your appointment. e.g. Permanent Resident Card (Green Card)/number; Passport/number; VISA; Employment Authorization card/number Naturalization Certificate/registration number and certificate number
• Receipt number for confirmation to adjust immigration status
• If recently released from incarceration, documentation to show you are no longer incarcerated. (Release paperwork, current pay stub, letter from employer, current postmarked envelope, detailed statement from a Parole Officer)

We look forward to meeting with you. Should you need to reschedule your appointment, kindly call us as soon as possible at: (607)772-0517 or 1-800-231-0744.