Insurance Forms Document Center
This document center includes frequently used forms for all the plans provided through the Chemung County Insurance Department. If you are not sure which forms you should complete, refer to your union or group plan summary (links below) with plan lettering to verify which plans pertain to you or contact the Chemung County Insurance Department.
Chemung County Employee Benefits
Municipality/Special District Employees
Eligibility requirements should be discussed with the Chemung County Insurance Department or your participating employer group.
Refer to the Subscriber Responsibility (PDF) for dependent eligibility and required documentation.
All enrollment forms must be returned to the Chemung County Insurance Department for processing. Do not submit them directly to your insurance plan carrier. The 'other insurance coverage information' form should be completed every time you complete enrollment forms.
All claim forms are sent to your insurance plan carrier directly. Do not send them to the Chemung County Insurance Department.
Are you looking for Chemung County Employee Insurance Buyout Form or Chemung County Employee Change Coverage Form? Those forms are only posted on the County Intranet site under Insurance.