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Health Care Claim Form Section 1Plan Member InformationPlease print clearlyName of Plan MemberIdentification No. Address Home TelephoneSection 2Work TelephonePatient Information (Only include names

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What is 13483a health0812988-eng?

13483a health0812988-eng is a form used for reporting health coverage information to the IRS.

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The purpose of 13483a health0812988-eng is to report health coverage information to the IRS and to individuals who have health coverage.

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Information such as the name of the covered individual, the length of coverage, and the type of coverage must be reported on 13483a health0812988-eng.

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