Workers compensation managed care premium credit programs - dfs ny 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your company name and contact information, including email address and phone number, in the designated fields.
3. In the compliance questionnaire section, ensure all applicable items are answered. If an item does not apply, enter 'NA' in the corresponding column.
4. For each requirement listed under 'A. Submission includes', check 'YES' or 'NO' based on your documentation. Make sure to attach necessary documents like contracts and approvals.
5. Specify the amount of credit you are applying for, ensuring it does not exceed 10%. Fill in the percentage field accurately.
6. Review all entries for completeness and accuracy before submitting your form to avoid delays in processing.

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