Get Comprehensive Health Insurance Pool (chip) - Nebraska ...

Filling out the Comprehensive Health Insurance Pool (CHIP) form online is an essential task for insurers operating in Nebraska. This guide provides clear and supportive instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the CHIP form online.

1. Press the ‘Get Form’ button to access the CHIP form and open it in your preferred editing tool.
2. Begin by entering your Nebraska company S.B.S. number, followed by the contact person's name.
3. Next, fill in your company's NAIC number, telephone number, and email address in the designated fields.
4. Provide your company name and complete address, including city, state, and nine-digit zip code.
5. Report the total Nebraska accident and health insurance premiums as indicated, using the appropriate figures from your annual statement.
6. Subtract any Nebraska premiums that are not considered health insurance under CHIP from the total reported.
7. Calculate and document the total group and individual health insurance premiums in Nebraska.
8. If applicable, indicate the amount of premium earned from your individually underwritten group association business.
9. Provide the most commonly used trend number for individual major medical health insurance policies throughout the reporting year.
10. Ensure you include your signature along with the title and organization on the document. Date and notarize the form as required.
11. After completing the form, save your changes. You may then download, print, or share the form as necessary.

Complete and submit your documents online to ensure compliance and avoid administrative action.