Click on the icons in the "Upstate" column if you are located in one of the following counties: Albany, Clinton, Essex, Fulton, Montgomery, Rensselear, Saratoga, Schenectady, Schoharie, Washington and Warren. For members located in all other counties choose "Downstate”.
Dental Claim Form
Authorization to Release Information
Authorization to Release Information - Spanish
International Emergency Dental Program Flyer
International Emergency Dental Program Frequently Asked Questions
Disabled Dependent/Michelle’s Law Application
Extra cleaning sign up form for diabetic and pregnant members