Free Insurance Claim Forms and Templates
What Is an Insurance Claim?
An Insurance Claim Form is a formal written request that a policyholder submits to their insurance company (or government entity) to request coverage or compensation for a covered loss or policy event. The insurance company reviews the Insurance Claim and — if the claim is approved — issues payment to the policyholder or a verified interested party acting on the policyholder’s behalf.
Insurance Claim Forms
- Form CMS-1500, Health Insurance Claim Form (and Form HCFA-1500). The document was developed by the Centers for Medicare & Medicaid Services and is used by the patients with existing coverage of medical expenses. The application must be signed by a patient and a physician (or a supplier).
- EDD Unemployment Insurance Application. Individuals submit the correct version of Form DE 1101ID to the California Employment Development Department to file or reopen their claim for unemployment benefits.
- Unemployment Insurance Claim. If an individual becomes unemployed, they may file an Unemployment Claim with local authorities to receive their unemployment compensation benefits. All states have their own version of this claim form - some have are available for e-filing only.
Not what you were looking for? Check out these related forms:
- IRS Form 1095-A, Health Insurance Marketplace Statement, provides members of the Health Insurance Marketplace data about their policies and options;
- IRS Form 1095-B, Health Coverage, used to verify eligibility for health coverage;
- IRS Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, used by Applicable Large Employers (ALE) to inform their employees about health insurance coverage;
- IRS Form 8962, Premium Tax Credit, used for calculating the premium tax credit.
Documents:
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This form is used for submitting a wellness claim to Allstate insurance company in Florida.
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This form is used for claimants in Missouri to request an appeal
This form is used for filing a joint low earnings claim for partial unemployment benefits in the state of Tennessee.
This Form is used for filing a stroke claim with Cblife insurance company.
This type of document is used for reporting death claims to Gulf Guaranty Life Insurance Company.
This is an Arizona legal document needed to verify that you were unemployed during the report week and are eligible to receive Arizona Unemployment Insurance or AZUI.
This form is used for claimants in Colorado to waive their rights and authorize the release of information.
This form is used for reporting changes in aggregate claims administration in the state of Florida.
This form is used for filing a claim for disaster unemployment assistance (DUA) in the state of Missouri. It provides information on how to file for DUA benefits in the event of a disaster.
This form is used for filing a weekly claim for unemployment insurance desk certification in the state of Georgia, United States.
This Form is used for claiming bonus pay in the state of Kansas.
This Form is used for filing a labor dispute statement by a claimant in Kansas. It is used to initiate a claim related to a labor dispute and provide relevant information about the issue at hand.
This Form is used for providing a Reasonable Assurance Statement for claimants in Kansas. It is used to establish eligibility for certain benefits or claims.
This form is used for the Weekly Claim Form in the Self Employment Assistance (SEA) Program in Oregon.
This Form is used for filing an appeal for unemployment insurance benefits in Vermont.
This form is used for individuals in New York who want to request a hearing for their claim.
This document is used for claimants in South Dakota to update their name and address information.
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 Form is used for submitting health insurance claims. It is a standard form that healthcare providers use to request payment from insurance companies for the services they provide to patients.
This form is used for requesting the withdrawal of a claim in the state of Hawaii.
This Form is used for the Interstate Intercept program in Illinois. It is an agreement statement for claimants participating in the program.
This form is used for applying for unemployment insurance in the state of Illinois.
This form is used for claimants in Iowa to provide an affidavit and grant power of attorney. It helps individuals assert their legal rights and manage their claims effectively.
This document is used for claimants in Iowa to submit an affidavit with their alternate base period wage information for unemployment benefits.
This form is used for job refusal statement by a claimant in Kansas.
This form is used for requesting reemployment trade adjustment assistance claim in Missouri.
This form is used for filing a continued claim for unemployment benefits in the state of New Hampshire. It allows individuals to provide updated information and certify their ongoing eligibility for benefits.
This form is used for filing continued unemployment claims in New Hampshire for training purposes.
This Form is used for filing a continued claim for unemployment benefits in the state of New Hampshire.
This document is used to record a claim in the state of New Jersey. It provides an official record of the details and information related to the claim.
This Form is used for filing a claimant's affidavit of federal civilian service wages and reason for separation for the Unemployment Compensation for Federal Employees (UCFE) program in North Dakota.
This form is used for filing an initial claim for unemployment benefits in the state of Oregon. It is necessary for individuals who have recently become unemployed and wish to apply for financial assistance.
This form is used for residents of Utah to make a statement regarding their claims for benefits.
This document is used for making a statement regarding a claim for worker's compensation benefits in Utah.
This Form is used for claimants in Utah to provide a statement about voluntarily quitting their job.
This form is used for claimants in Utah to provide a statement regarding their job discharge.
This Form is used for claiming a change of address in Vermont.
