Massachusetts Health Insurance Form

Boston ma 02114 hours.

Massachusetts health insurance form. In massachusetts medicaid and the children s health insurance program chip are combined into one program called masshealth. Masshealth members may be able to get doctors visits prescription drugs hospital stays and many other important services. Browse our insurance forms library. Senior and long term care applications cannot be processed at these locations.

State law requires every employer in massachusetts who had six or more employees in any month during the past 12 months preceding the november 30 due date of this form december 1 2017 november 30 2018 to submit a hird. This form is provided by your health insurance carrier and not the gic. Complete if you answered line s 4a or 4e and go to line 5. Monday through friday 8 a m.

Use this form to show your eligibility. Every commonwealth of massachusetts resident who has health insurance will receive a 1099 hc form. These documents have been added for your convenience and may be viewed downloaded and printed at any time. Massachusetts has resurrected a version of the health insurance disclosure form hird.

Personal lines insurance forms massachusetts motor vehicle insurance application flood insurance application watercraft application ballpark request form homeowners insurance application. From box 2 of form ma 1099 hc subscriber number from form ma 1099 hc 4g spouse s health insurance. Name of second private insurance company administrator or other government program if necessary from box 1 of form ma 1099 hc federal identification number of insurance co. Massachusetts health connector walk in centers.

Masshealth members may be able to get doctors visits prescription drugs hospital stays and many other important services. You and your dependents must live in massachusetts to renew your individual health plan with blue cross blue shield of ma. You can also visit one of the massachusetts health connector walk in centers for in person help. Massachusetts is a leader in public health and healthcare reform enacting legislation in 2006 that resulted in the nation s lowest uninsured rate a designation the state continues to hold with an uninsured rate of just 2 8 percent in 2018 according to u s.

A form authorizing blue cross blue shield of massachusetts to send specific information to a specific individual. The 1099 hc form is a massachusetts tax document which provides proof of health insurance coverage for massachusetts residents. The hird reporting is administered by masshealth and the department of revenue dor through the masstaxconnect web portal. Massachusetts reform strategies such as an exchange where private insurers compete a requirement that.