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NEW YORK STATE DEPARTMENT OF HEALTH Merger-Acquisition Division of Finance and Rate Setting HEALTH CARE REFORM ACT PUBLIC GOODS POOL DOH-4406 INSTRUCTIONS Name of Acquiring Company/ Federal ID Number Enter legal name of acquiring company and their federal employer identification number FEIN. Enter date all NY claims were adjudicated. Is the Acquiring Company a Participant as an Elector in the NYS Public Goods Pool Check the appropriate box yes o.

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Call the NY State of Health Customer Service Center at 1-855-355-5777.

There is no monthly premium for families whose income is less than 2.2 times the poverty level. That's about $1150 a week for a three-person family, about $1387 a week for a family of four.

We are also accepting service by email sent to OGC@health.nyc.gov.

DOH-4399 INSTRUCTIONS A payor voluntarily electing to make public goods payments directly to the Office of Pool Administration must complete forms DOH-4399 (Payor Election Application) and DOH-4264 (Electronic Filing User ID Application).

Call the Marketplace at 1-855-355-5777 for more information or help applying for coverage in your language. All help is free.

The NY State of Health is mainly for: People who don't have insurance through a job or Medicare. New Yorkers under 65. New York Small Businesses with 100 or fewer employees.

The New York Public Goods Pool is a fund created by the state of New York to finance health care initiatives and care for the indigent within that state. The Pool was started in 1997 and is funded by a surcharge tax on all health services rendered in the state of New York.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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:
1-877-389-0141
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