Health Coverage Templates

This document provides information about health coverage options available through employment in Alabama. It includes details about the types of coverage, eligibility requirements, and how to enroll.

This document is used for applying for health coverage and financial assistance in Washington, D.C. It helps individuals and families access affordable healthcare options and determine if they qualify for financial help.

This Form is used for explaining the medical benefits provided under Wisconsin's F-01234 Form. It provides instructions on how to understand and utilize these benefits.

This form is used for requesting dependent out-of-area benefits in West Virginia.

This Form is used for Medicaid and State Supplemental Review in the state of Iowa.

This is an IRS document released for those individuals who got payments during the calendar year of qualified health insurance payments for the benefit of eligible trade adjustment assistance.

This Form is used for reporting changes to Medicaid benefits in Wisconsin for individuals who speak Hmong.

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 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 enrolling in a Cobra health insurance plan in Maryland.

This Form is used for applying for health coverage and assistance with costs in Missouri.

This document provides training on the process of presumptive eligibility for hospitals in Nevada. It explains how hospitals can determine eligibility for certain individuals to receive temporary Medicaid coverage.

This document is used for applying for health coverage and financial assistance for healthcare costs in the state of Alabama.