Health Insurance Form Templates

This form is used for notifying individuals in Texas about the services offered by the Managed Care Program.

This form is used for communicating with managed care programs in Texas. It is used to provide information or request assistance related to healthcare services.

This Form is used for obtaining an Out Card from the Texas Health and Human Services Commission (HHSC). An Out Card allows individuals to temporarily leave a HHSC facility and return within a specified period.

This form is used to notify the Medicaid Buy-In for Children program in Texas about changes in monthly payments or cost share limits.

This form is used for providing important medical information in Canada. It is an important document to ensure that relevant medical information is available when needed.

This document provides a reference chart for the Special Enrollment Periods under the Health Reform. It helps individuals understand when they may be eligible to enroll in health insurance outside of the regular open enrollment period.

This document provides information about health insurance continuation for residents of Dekalb County, Illinois, under the Consolidated Omnibus Budget Reconciliation Act (COBRA) or Health Insurance Continuation under Illinois Insurance Code Section 367j. It outlines the rights and options available for individuals who have lost or are losing their health insurance coverage.

This document provides information about the new health insurance marketplace coverage options and how they may affect your current health coverage. It explains the benefits and enrollment process for these new options.

This form is used for enrolling in the Montana Voluntary Employees' Beneficiary Association (VEBA) program.

This document provides instructions for completing Form FA-24A which is used for coordinating hospice services and waiver or personal care services (PCS) in Nevada.

This form is used for submitting an attestation for a Qualified Health Plan (QHP) in the state of Kansas.

This form is used for requesting information related to Medi-Cal benefits in California. It is available in the Cambodian language.

This Form is used for California residents who speak Lao and need to submit a request for information related to Medi-Cal.

This Form is used for filing certification of accident and health insurance in the state of Utah.

This form is used for applying for uninsured medical coverage in the state of Nevada.

This form is used for verifying long-term care insurance policies in Texas.

This document provides projections for national health expenditure in the United States from 2012 to 2022. It shows predicted trends and estimates for healthcare spending over the next decade.

This document provides essential information for employees about their health benefits under COBRA. It covers topics such as eligibility, coverage duration, and the rights and responsibilities of employees.

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.

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 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 document allows Children's Integrated Services in Vermont to seek permission to bill both private and public insurance for services provided.

Individuals who reside in British Colombia may use this form when they would like to apply to enter the Medical Service Plan (MSP).

This document outlines the way in which a patient's Protected Health Information (PHI) may be disclosed to third parties.

This form is used for requesting prior authorization for extended release opioids in the state of Alaska.

This form is used for consenting to the use of private insurance in Missouri. It is available in Kinyarwanda language.