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Oxford Medical Enrollment Form - Benefits Management Group

Oxford Medical Enrollment Form - Benefits Management Group 2026

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4.8 out of 5

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The document is a New York Member Enrollment Form for Oxford Health Insurance, intended for employers and employees to provide necessary information for health coverage enrollment. It includes sections for employer details, employee personal information, dependent information, prior health insurance details, and declarations regarding existing health coverage. The form emphasizes the importance of accurate completion to avoid processing delays and outlines the consequences of fraudulent information.

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Click ‘Get Form’ to open the Oxford Medical Enrollment Form in our editor.
Begin by filling out the employer section. Enter the GROUP NUMBER, NAME OF GROUP, and CONTRACT SPECIFIC PACKAGE. Ensure all fields are printed clearly.
Next, provide your EMPLOYEE’S EFFECTIVE DATE OF COVERAGE and indicate if you are covered under COBRA by selecting YES or NO.
Complete the employee information section by entering your LAST NAME, FIRST NAME, MI, BIRTH DATE, and STREET ADDRESS. Make sure to include your SOCIAL SECURITY NUMBER.
For dependents, fill in their details including names, birth dates, and social security numbers. Indicate if they have any other health coverage.
Review all entries for accuracy before signing at the bottom of the form. Your signature confirms that you understand the terms outlined in the enrollment form.

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Versions	Form popularity	Fillable & printable
2002	4 Satisfied (59 Votes)
1999	4.8 Satisfied (22 Votes)

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What happened to UnitedHealthcare?

In the last month alone, UnitedHealth Group has lost nearly $300 billion of its $600 billion market cap following Wittys exit, the companys rough first-quarter earnings and a reported criminal probe into possible Medicare fraud.

Are Oxford and UnitedHealthcare the same?

Oxford Health Plans is a part of the UnitedHealthcare Company. Medical plans can generally be purchased in 3 states: Connecticut, New Jersey, and New York. Coverage is available to individuals, families, and employers. There is a choice of Point of Service (POS) plans, which include the Freedom Plan and Liberty PlanSM.

What happened to Oxford Health Insurance?

If you have questions related to OBM, you can contact us via e-mail at obm@ancillary-benefits.com, or contact Member Services at 1-800-521-9845. The phone number provided will give you access to OBM and OBM partners, who can assist you with questions specific to: Claims and claims payments.

Is Oxford an UHC plan?

Oxford Benefit Management products are provided by: UnitedHealthcare Dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates.

Is Oxford insurance the same as UnitedHealthcare?

In 1997 the firm had been fined $3 million for a variety of legal violations amidst false claims of alleged profits that included double counting of premiums. In 2004 it merged with UnitedHealth Group.

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