PDF
Word
Form 4930 Quarterly Worksheet for Health Insurance Claims Assessment (Hica) - Michigan
What Is Form 4930?
This is a legal form that was released by the Michigan Department of Treasury - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 4930?A: Form 4930 is the Quarterly Worksheet for Health Insurance Claims Assessment (HICA) in Michigan.
Q: What is the purpose of Form 4930?A: The purpose of Form 4930 is to report health insurance claims assessment information.
Q: Who needs to file Form 4930?A: Insurance companies, health maintenance organizations, and third party administrators are required to file Form 4930.
Q: How often is Form 4930 filed?A: Form 4930 is filed quarterly.
Q: What information is required on Form 4930?A: Form 4930 requires information about health insurance claims paid during the quarter, including the amount of claims paid and the number of covered lives.
Form Details:
- Released on January 1, 2017;
- The latest edition provided by the Michigan Department of Treasury;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 4930 by clicking the link below or browse more documents and templates provided by the Michigan Department of Treasury.
Download Form 4930 Quarterly Worksheet for Health Insurance Claims Assessment (Hica) - Michigan
1
2
3
