Health Insurance Form Templates

This Form is used for electing participation in Flexible Spending Accounts under the Federal Judiciary Benefits Program.

This form is used for small businesses in Arizona to apply for a Certificate of Eligibility for the Health Insurance Premium Tax Credit.

This form is used for applying for premium assistance subsidy in California. It helps individuals and families qualify for financial support in paying for their health insurance premiums.

This Form is used for reporting information about health insurance coverage through the California Health Insurance Marketplace. It provides important details that are required for tax purposes in California.

This form is used for collecting health insurance information in the state of California.

This type of document is used for notifying the change of health insurance status in Warren County, Ohio.

This form is used for providing health insurance information in Warren County, Ohio.

This document provides the child support and health insurance language specifically for ex parte orders in Butler County, Ohio.

This Form is used for submitting a health insurance affidavit in Franklin County, Ohio.

This document outlines the reporting requirements for businesses that are considered "applicable large employers" under the Affordable Care Act. It explains the information that these employers need to provide to the government regarding their health insurance coverage for employees.

This is a contract used in Florida that is signed by both an employee and their legal employer when they secure a job offer within a business and agree to start working there.

This form is used for coordinating benefits between different health insurance plans. It helps ensure that your claims are processed correctly and prevents overpayment or duplication of benefits.

This Form is used for renewing the application for Pharmacy Benefit Managers (PBM) in West Virginia.

This document is a statement that provides details about health insurance coverage in Cuyahoga County, Ohio.

This document provides support and health insurance information for residents of Cuyahoga County, Ohio. It is a resource for individuals seeking assistance with accessing and understanding healthcare coverage options in the county.

This document is for renewing the Pharmacy Benefits Manager (PBM) in Delaware.

This form is used for enrolling in Home Health Telehealth services under Health First Colorado in Colorado.

This checklist is used to guide residents in Georgia on the important factors to consider when getting insurance coverage. It covers various types of insurance such as auto, home, and medical.

This form is used for claiming Industrial Injuries Disablement Benefit in the United Kingdom due to occupational deafness.

This form is used for obtaining authorization under the Health Insurance Portability and Accountability Act (HIPAA) for volunteers involved with the World Trade Center in New York.