Form preview

Get the free NEW YORK PUBLIC GOODS POOL COVERED LIVES SUPPLEMENTAL REPORT - health ny

Get Form
This document serves as a report for the New York Public Goods Pool, detailing covered lives, including individuals and family units across various regions, and associated assessment rates and liabilities.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign new york public goods

Edit
Edit your new york public goods form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your new york public goods form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit new york public goods online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use our professional PDF editor, follow these steps:
1
Log in to your account. Start Free Trial and register a profile if you don't have one yet.
2
Upload a document. Select Add New on your Dashboard and transfer a file into the system in one of the following ways: by uploading it from your device or importing from the cloud, web, or internal mail. Then, click Start editing.
3
Edit new york public goods. Text may be added and replaced, new objects can be included, pages can be rearranged, watermarks and page numbers can be added, and so on. When you're done editing, click Done and then go to the Documents tab to combine, divide, lock, or unlock the file.
4
Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.
With pdfFiller, it's always easy to work with documents.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out new york public goods

Illustration

How to fill out NEW YORK PUBLIC GOODS POOL COVERED LIVES SUPPLEMENTAL REPORT

01
Obtain the NEW YORK PUBLIC GOODS POOL COVERED LIVES SUPPLEMENTAL REPORT form from the appropriate state agency or website.
02
Fill in the required identification information, including the name of the organization and contact details.
03
Specify the reporting period for which the data applies, ensuring all dates are accurate.
04
List all covered lives, including details such as name, date of birth, and coverage start date.
05
Verify that all data is complete and accurate before submission.
06
Sign and date the report where indicated, ensuring that the person signing has authority to do so.
07
Submit the completed report to the designated authority, whether electronically or via mail, according to agency guidelines.

Who needs NEW YORK PUBLIC GOODS POOL COVERED LIVES SUPPLEMENTAL REPORT?

01
Insurance companies operating in New York that are required to report covered lives for public goods pooling.
02
Healthcare providers that participate in public goods programs.
03
Regulatory agencies monitoring coverage and public health statistics.
04
Any organization seeking to comply with state regulations regarding public goods pool contributions.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
54 Votes

People Also Ask about

The New York Health Care Reform Act (NYHCRA) has been in effect since Jan. 1, 1997. It imposes certain surcharges and assessments on a variety of healthcare physician/other healthcare professional services received in New York State by a covered member.
What is the Pool? The New York Public Goods Pool is a fund created by the state of New York to finance health care initiatives and care for the indigent within that state. The Pool was started in 1997 and is funded by a surcharge tax on all health services rendered in the state of New York.
Announced tentative regional rates for inpatient services include 25.09 percent for New York City, 11.96 percent for Long Island and 9.05 percent for Westchester County. Thus, the amount of the surcharge will generally vary depending on how the taxes are paid and where services are provided.
The City Sales Tax rate is 4.5%, NY State Sales and use tax is 4% and the Metropolitan Commuter Transportation District surcharge of 0.375% for a total sales and use tax of 8.875 percent.
In these situations, responsibility for payment of the HCRA surcharge rests with the private insurance carrier, at rates based on their election status, plus if applicable, a regional GME percentage, when billed.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The New York Public Goods Pool Covered Lives Supplemental Report is a document that provides detailed information on the number of covered lives under various health insurance policies in New York. It is utilized to assess the overall risk pool and ensure adequate funding for public health initiatives.
Health insurers, health maintenance organizations, and other entities that provide coverage for health services in New York are required to file the New York Public Goods Pool Covered Lives Supplemental Report.
To fill out the report, insurers must gather data on the number of covered lives from their policies, fill in standardized forms provided by the New York Department of Financial Services, and ensure accuracy before submission by the deadline.
The purpose of the New York Public Goods Pool Covered Lives Supplemental Report is to collect and compile data necessary for the maintenance of the Public Goods Pool, which funds health-related programs and initiatives aimed at improving public health outcomes in New York.
The report must include information such as the total number of covered lives, types of insurance coverage provided, demographic data of the insured populations, and any other relevant metrics specified by the regulatory authorities.
Fill out your new york public goods online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.