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Click ‘Get Form’ to open it in the editor.
Begin by entering the Employer's ID Number and NAIC Company Code in the designated fields. This information is crucial for identifying your organization.
Fill in the organizational details, including the date incorporated and business commencement date. Ensure accuracy as this reflects your company's history.
Complete the contact information section, including addresses and phone numbers for both the statutory home office and administrative office. This ensures proper communication channels are established.
In the officers' section, input names and titles of key personnel. This provides transparency regarding leadership within your organization.
Review all financial statement sections carefully, ensuring that revenue and expense figures are accurately reported based on your records.

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What is the income limit for the Healthy Michigan health Plan?

Individuals are eligible for the Healthy Michigan Plan if they: Are age 19-64 years. Have income at or below 133% of the federal poverty level* ($16,000 for a single person or $33,000 for a family of four)

What kind of insurance is the Healthy Michigan plan?

As of Aug. 30, 2024, Physicians Health Plan (PHP) is now University of Michigan Health Plan (UM Health Plan). While this change marks a signiﬁcant milestone in our companys 40+ year history, who we are as an organization remains the same.

Whats the maximum income to qualify for Medicaid in Michigan?

See if you qualify for the Healthy Michigan Plan. Have income at or below 133% of the federal poverty level* (about $18,000 for a single person or $37,000 for a family of four)