NY HIMP-1 2018-2026 free printable template
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New York State Workers Compensation Board Health Insurance Matching Program Part I Health Insurer's/Health Benefit Plan's Request for Reimbursement Claimant's Name Case NumberClaimant's Social Security
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How to fill out NY HIMP-1
01
Obtain the NY HIMP-1 form from the official New York State Health Department website or your local health department office.
02
Ensure you have all required information handy including your name, contact details, and any pertinent medical history.
03
Carefully read the instructions provided with the form to understand the purpose and requirements.
04
Fill in the personal information section at the top of the form, making sure all details are accurate.
05
Provide any required medical information and history as indicated on the form, being thorough and honest.
06
Review the completed form for any errors or missing information before submission.
07
Submit the form as instructed, either by mailing it to the appropriate address or submitting it electronically if available.
Who needs NY HIMP-1?
01
Individuals who are involved in or affected by specific health care or public health initiatives in New York.
02
Healthcare providers who need to report on certain public health issues or population health data.
03
Organizations collecting health-related data for research or program evaluation purposes.
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What is NY HIMP-1?
NY HIMP-1 is a form used in New York State for reporting the health insurance marketplace participation of individual applicants.
Who is required to file NY HIMP-1?
Individuals and organizations that engage in the health insurance marketplace reporting and must report their participation and related information.
How to fill out NY HIMP-1?
To fill out NY HIMP-1, provide the required personal and organizational details, answer all relevant questions accurately, and submit it according to the specified guidelines.
What is the purpose of NY HIMP-1?
The purpose of NY HIMP-1 is to facilitate the reporting of health insurance marketplace participation, ensuring compliance with state regulations.
What information must be reported on NY HIMP-1?
Information that must be reported includes applicant details, insurance coverage levels, organization information, and data pertaining to marketplace participation.
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