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400 Attachment 2-T DOH-4400 Attachment 2.4A DOH-4401 TPA/ASO Client List Addendum Additions Attachment 2.4B DOH-4411 TPA/ASO Client List Addendum - Deletions Attachment 2.5 DOH-4402 Payor Status Change Attachment 2.6 DOH-4403 TPA/ASO Status Change Attachment 2.7 DOH-4404 Request to Rescind Election Status Attachment 2.8 DOH-4406 Merger/Acquisition Attachment 2.9 DOH-4409 Payor/TPA Name/Address Change Attachment 2.10 DOH-4407 Provider Name/Address Change Attachment.

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The 1996 New York Health Care Reform Act (NYHCRA) provided for two levies: A surcharge on defined claims for indigent care and health care initiatives; An assessment fee for Graduate Medical Education (GME), based on New York state residency.

State of New York Health Care Reform Act – Public Goods Pool. The New York Health Care Reform Act (NYHCRA) imposes certain surcharges and assessments on a variety of health care physician/other health care professional services received in New York state by a covered member.

Some insurance carriers will pay the NY State Surcharge on your behalf, but this varies by insurance carrier. If your insurance carrier did not pay this tax or you do not have healthcare coverage, you are responsible for paying the NY State Surcharge and we are required to pay the collected Surcharge to the State.

A surcharge created by the Health Care Reform Act (HCRA) of 1996 is collected from health plans in the form of a sales tax on certain hospital-based health services. The surcharge was originally designed to help reimburse hospitals for losses incurred by bad debt and charity care.

For services delivered from April 1, 2009, through Dec. 31, 2023, the surcharge is 9.63% for electing payors that pay this expense to the Public Goods Pool and an additional 28.27% (or a total of 37.9%) for nonelecting payors that pay the surcharge to providers.

The 2.2% surcharge is collectible primarily from tenants in market rate units in buildings that receive 421-a (subdivision 1-15) tax benefits.

Self funded plans that choose not to elect into the Pool will be charged a surcharge tax of 35.21% on any claim incurred in the state of New York, with additional regional fee on top of that for inpatient claims.

If your insurance carrier did not pay this tax or you do not have healthcare coverage, you are responsible for paying the NY State Surcharge and we are required to pay the collected Surcharge to the State. If you have questions about your bill, call the phone number on your billing statement.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232