Health Insurance Form Templates

This document is a consent form used in Missouri for individuals who want to use their private insurance for healthcare services and it is available in Japanese.

This form is used for obtaining consent to use Mo Healthnet/Medicaid in the state of Missouri by Kurdish-speaking individuals.

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

This form is used for providing confidential employment and health insurance information in the state of Nebraska. It helps individuals to disclose their personal and medical details to relevant parties in a secure manner.

This form is used for applying to the Nevada Health Insurance Premium Payment (HIPP) Program.

This Form is used for requesting prior authorization for growth hormone treatment for recipients under the age of 21 in Nevada.

This form is used for requesting prior authorization for the use of topical androgen agents in the state of Nevada.

This Form is used for requesting prior authorization for targeted immunomodulators in Nevada. It helps ensure that the use of these medications is appropriate and meets necessary criteria.

This form is used to apply for presumptive eligibility for Medicaid in Nevada. It allows individuals to receive temporary coverage while waiting for their full Medicaid application to be processed.

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 also known as the healthcare marketplace tax form. It is used to inform the IRS about individuals and families enrolled in a health plan via the Health Insurance Marketplace.

This Form is used for reporting health coverage exemptions on your federal income tax return. It is used to claim exemption from the requirement to have health insurance or pay a penalty.

This form is used for applying for health insurance in New York.

This Form is used for Attending Doctors in New York to request a determination for medical authorization.

This Form is used for declaring the coverage of a Group Health Plan in Ohio. It provides a certificate stating the details of the plan and the coverage it offers.

This Form is used for providing health insurance information in the state of New Jersey.

This document is used for submitting a request to enroll or make changes to a group insurance plan in the state of New Jersey.

This document is an application for a Certificate of Authority for a Managed Care Organization (WCMCO) in the state of New Jersey. It is used to request authorization to operate as a managed care organization in the state.

This document is an application form for the Newfoundland and Labrador Prescription Drug Program (NLPDP) in Canada. It is used to apply for coverage for prescription drugs in the province of Newfoundland and Labrador.

This form is used for applying to be a payor under New York State law. It allows individuals or organizations to request approval to make insurance payments on behalf of injured persons.

This form is used for applying for health care coverage in the province of Nunavut, Canada. It is necessary to fill out this application to access health services in Nunavut.

This Form is used for obtaining approval for the Insulin Pump Program (IPP) in New Brunswick, Canada.

This form is used for seniors in Saskatchewan, Canada to apply for the annual drug plan.

This Form is used for applying to the Seniors' Drug Plan in Saskatchewan, Canada. It includes the Consent to release information to CRA (Canada Revenue Agency).

This document is used to request information on the medical claims history of an individual in Newfoundland and Labrador, Canada. It is commonly used by insurance companies and healthcare providers to gather relevant information for assessing claims and determining coverage.