Health Insurance Form Templates

This form is used for filing complaints against providers and partners of the Oregon Health Plan.

This document is used to notify individuals in Oregon, who speak Chinese, about their approval for temporary coverage under the Oregon Health Plan.

This form is used for enrolling in a Medicare Advantage Plan in Oregon.

This form is used for giving authorization to someone to obtain your health information in the state of New Mexico.

This Form is used for submitting a prior authorization or vision attachment for healthcare services in Wisconsin. It provides instructions on how to complete the form and includes important information for the authorization process.

This Form is used for providing instructions on how to complete Form F-01629 Prior Authorization/Behavioral Treatment Attachment (PA/BTA) in the state of Wisconsin. It is important to follow these instructions carefully in order to ensure proper submission of the form.

This form is used for the Wisconsin Adult Cystic Fibrosis Program to assess the financial need of individuals applying for assistance.

This form is used for certifying eligibility for health insurance subsidies in Florida.

This form is used for retirees in Florida to apply for a health insurance subsidy for their investment plan.

This document is for residents of Prince Edward Island, Canada who want to apply for co-pay reimbursement under the Pei Eye See Eye Learn Program.

This document is used to request a determination of coverage for an insurance claim or benefit. It typically involves submitting information and evidence to support the request and may be required by the insurance company before they make a decision on coverage.

This document provides instructions on how to request a coverage determination.

This template is used to ensure that new students adapt to an educational establishment much quicker with the end goal of making them feel more comfortable and at home.

This document describes the process of repealing and replacing health-related tax policy in the United States. It provides information on changes to tax laws that impact healthcare and how they are being replaced with new policies.

This form is used for objecting to a payment bill for treatment provided in New York.

This form is filed by employers with 50 or more full-time employees in order to provide information about their enrollment in health coverage required under sections 6055 and 6056 of the Internal Revenue Code.

Download these cover sheets in order to report a summary about the Applicable Large Employer (ALE) and to transmit Form 1095-C, Employer-Provided Health Insurance Offer and Coverage to the Internal Revenue Service (IRS).

This form is used for renewing Medi-Cal benefits in California. It is available in Ukrainian language.

This Form is used for applying for the Ryan White Care program in the state of New Hampshire. The program provides HIV/AIDS-related medical care and support services to eligible individuals.

This form is used for opting out of health insurance coverage in Monroe County, New York.

This form is used for providing confidential employment and health insurance information in the state of Nebraska.

Esta documentación es para el programa Covered California para pequeñas empresas, que proporciona seguro médico asequible a empleados de pequeñas empresas en California.

This document is used for requesting treatment as an assistance eligible individual.

This form is used for the Masshealth Long-Term-Care Eligibility Review in Massachusetts. It is used to determine if individuals are eligible for long-term care services.