Health Coverage Templates

This document reports on Credit Life Insurance and Credit Accident & Health Insurance in the state of Utah. It provides information about these types of insurance policies and their regulations in Utah.

This form is used for applying for health and dental coverage for a domestic partner and their dependent children in Vermont.

This Form is used for applying for health coverage and financial assistance in Virginia.

This document is for applying for health coverage and financial assistance for medical costs in Virginia for individuals who meet the medically needy spenddown criteria. You can use Appendix E to seek help if you have high medical expenses but don't qualify for regular Medicaid.

This document provides a summary of health benefits offered in California. It outlines the different types of coverage available, as well as the costs and benefits associated with each plan. It is a useful resource for understanding the health insurance options in California.

This Form is used for renewing an Oregon OHP (Oregon Health Plan) eligibility.

This form is used for canceling health and dental coverage for domestic partnerships in Iowa.

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

Use this form if you are an insurance provider and wish to inform the IRS about taxpayers who are eligible to receive minimum essential health coverage that meet the standards of the Affordable Care Act.

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 used for renewing medical assistance for Magi-Excepted Households in Hawaii. It provides instructions for completing the renewal form DHS1100B-2.

This form is used for applying for household health coverage in Arkansas.

This form is used for applying for health coverage and help with costs in the state of Georgia, United States.

This Form is used for applying for health coverage and financial assistance in Hawaii.

This Form is used for applying for health coverage and assistance with cost payments in Hawaii.

This form is used for applying for health coverage and assistance with paying costs for individuals in Kentucky.

This form is used for applying for health coverage in Louisiana through the BHSF program.

This form is used for applying for health and dental coverage in Massachusetts and seeking financial assistance for paying the costs.

This Form is used for applying for health coverage for seniors and individuals who require long-term care services in Massachusetts.

This Form is used for applying for health coverage and financial assistance in Michigan.

This Form is used for applying for health coverage and financial assistance in New Jersey.

This Form is used for applying for health coverage and financial assistance in North Carolina.

This Form is used for applying for health coverage and financial assistance in North Carolina.

This Form is used for applying for South Dakota Medicaid/CHIP, health coverage, and assistance with paying costs in South Dakota.

This form is used for applying for health coverage and financial assistance to help pay for healthcare costs in the state of Tennessee.

This Form is used to apply for health coverage in the state of Vermont. It is specifically for residents who need to apply for insurance benefits.

This form is used for applying for supplemental health coverage in West Virginia.

This form is used for applying for health coverage and financial assistance in West Virginia.