Health Insurance Form Templates

This type of document allows individuals in Alaska to refer themselves to the Medicaid Coordinated Care Initiative (AMCCI) for coordinated healthcare services.

This document allows individuals to request the transfer of their Health Savings Account (HSA) funds and gives consent for the transfer in the state of Arkansas.

This is an IRS legal document completed by individuals who need to figure out the amount of their Premium Tax Credit and reconcile it with the Advanced Premium Tax Credit (APTC) payments made throughout the reporting year.

This form is used for submitting health insurance claims. It is commonly used by individuals to request reimbursement for medical expenses.

This document is a consent form for individuals in Missouri who speak Kinyarwanda to give their permission for the use of Mo Healthnet/Medicaid.

This form is used for documenting the findings related to Form H1852 in the state of Texas.

This form is used for filing the Privilege and Retaliatory Tax Return for Life and Accident and Health Companies in the state of Illinois.

This form is used for health maintenance organizations, limited health service organizations, voluntary health service plans, and dental service plans to file their Privilege and Retaliatory Tax Return in Illinois.

This form is used for conducting coverage research in British Columbia, Canada.

This form is used for declaring hospital insurance coverage in British Columbia, Canada.

This form is used for requesting reimbursement for medical expenses incurred in British Columbia, Canada.

This form is used for submitting out-of-country medical claims in the province of British Columbia, Canada.

This form is used for requesting changes to the Medical Services Plan (MSP) in British Columbia, Canada.

This document proves that an individual's previous insurance policy has ended.

This form is used for health insurance enrollment in the state of Utah. It provides information about the individual's health insurance coverage details.

This form is used for insurance agents or companies in Kentucky to certify health insurance for a health insurance reimbursement plan.

This form is used for employer certification of health insurance for a health insurance reimbursement plan in Kentucky.

This form is used for residents in Kentucky to apply for reimbursement of medical insurance expenses.

This form is used for EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) visits for individuals aged 11-21 in Mississippi. It is a required form for eligible individuals to receive comprehensive health services.

This Form is used for transmitting medical bills in the state of Texas. It is used to submit medical bills and documents to the appropriate agencies for processing and payment.

This Form is used for small businesses in California to apply for coverage through Covered California for Small Business.

This form is used for blind vendors in Nevada to enroll in health insurance.

This form is used for making a request to the Agency Based Community Benefits (ABCB) in New Mexico to terminate your participation in the Centennial Care program and switch from Self-directed Community Benefits (SDCB) to ABCB.