Health Insurance Form Templates

This form is used for requesting a refund for health, dental, life, and long-term disability insurance in the state of Iowa.

This type of document provides comprehensive health insurance coverage for residents of Nebraska who have pre-existing medical conditions and are unable to obtain coverage through private insurance companies.

This form is used for the NWT Health Care Plan in Northwest Territories, Canada. It is the Temporary Absence form, which allows residents to request coverage during a temporary absence from the territory. The form is available in both English and French.

This form is used for enrolling in medical and dental insurance coverage in Vermont.

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.

This Form is used for applying for health coverage and financial assistance in Hawaii. It provides instructions on how to complete the DHS1100 Application accurately.

This form is used for notifying changes in the Northwest Territories Health Care Plan in Canada. It is available in both English and French.

This form is used for requesting prior authorization for the Incontinence Supply Family Support 360 Waiver program in South Dakota.

This Form is used for appealing health benefits denials or decisions in the state of Virginia.

This form is used for applying for health insurance in California, specifically designed for individuals who speak Hmong.

This form is used for applying for medical benefits through mail in the state of Illinois.

This form is used for reporting long-term care and accelerated death benefits received during the tax year. It is used by individuals and insurance companies to report these benefits to the IRS.

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).

Use this document, otherwise known as the IRS Health Coverage Form, for submitting a report to the Internal Revenue Service (IRS) and to taxpayers about individuals with minimum essential coverage who are not liable for the individual shared responsibility payment.

This document is a survey conducted by health insurance carriers in Delaware. It gathers information about the health insurance needs and preferences of individuals in the state.

This document is used for Point of Service (POS) in Illinois. It pertains to a healthcare plan that allows participants to choose their own doctors and specialists.

This form is used for domestic partners in Iowa who want to reenroll in health and dental insurance.

This form is used for making adjustments to the trustee report for health and dental insurance in Iowa.

This form is used for acknowledging the applicant's request for personal lines and health and accident insurance coverage in the surplus lines market in Louisiana.

This form is used for reporting other health insurance information in Minnesota.

This Form is used for obtaining authorization for specialized wound therapy in the state of Minnesota. It is a necessary document for individuals seeking this type of medical treatment.

This form is used for applying for an insurance program in the state of Missouri.

This document is used for making changes to group coverage in Newfoundland and Labrador, Canada.

Physicians and other healthcare providers and professionals may use this legal document to submit claims for medical services. Form CMS-1500 provides information about the patient and insured, their diagnosis, treatment, and insurance details.

This document explains the relationship between Medicare and home health care services. It provides information about what Medicare covers and how to access home health care benefits.

An insurance policyholder may use and submit this letter to their insurance company with the intention of ending their insurance coverage.