Get Hmo Tennessee Form

Completing the Hmo Tennessee Form is essential for health maintenance organizations and TennCare providers to file their annual statement of premiums and fees for taxation. This guide provides a clear, step-by-step approach to ensure that users can accurately fill out the form online.

Follow the steps to successfully complete the Hmo Tennessee Form.

1. Press the ‘Get Form’ button to access the Hmo Tennessee Form and open it for editing.
2. Fill in the company name as the title of your organization. Make sure this is accurate, as it will be used for official purposes.
3. Provide the contact person's name who will be responsible for this filing. This ensures that there is a point of contact for any inquiries.
4. Enter the Federal Employer Identification Number (FEIN) for your organization. This unique identifier is critical for tax processing.
5. Fill in the address, including number and street, city, state, and zip code where your organization is located.
6. Input your email address to receive confirmations and communications related to your filing.
7. Specify the calendar year for which you are reporting. Ensure this aligns with the required filing period.
8. Provide the National Association of Insurance Commissioners company code (NAIC CO. CODE) if applicable.
9. Enter the telephone and fax numbers for your organization for further contact.
10. Indicate the date your organization was admitted to operate in Tennessee, along with the domiciliary state.
11. Proceed to the section where you report your premiums and corresponding taxes. Carefully add the amounts for both general premiums and TennCare dollars collected.
12. Calculate the total tax due by summing up the premiums and fees stated on the form. Ensure that this final amount is accurate.
13. Sign the form in the designated area, ensuring that the signature is original and includes the date.
14. Have the form notarized to confirm the authenticity of the information provided.
15. Save your changes, then download the completed form, printing or sharing it as necessary for submission.

Ensure that you file the Hmo Tennessee Form online to meet required deadlines and streamline your process.