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ReSource Pro Compliance | Insurance Licensing Services

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Home » Bulletins » New York Standard Form to Designate a Representative

New York Standard Form to Designate a Representative

NY | The New York Department of Financial Services has issued Insurance Circular Letter No. 1 (2024).

The purpose of this circular letter is to advise insurers that they should accept the standard form for an insured to designate a representative to assist with authorizations, complaints, grievances, and appeals as developed by the Department of Financial Services (“Department”). This form should be accepted when used with comprehensive health insurance, vision insurance, and dental insurance. This includes for Child Health Plus, Essential Plan, and Medicaid managed care coverage.

Click here for more information.

NYS Standard Form to Designate a Representative (PDF)

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    • Franchise / Foreign Corporation Tax Filings
  • Surplus Lines Tax Filings
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