Get Pormularyo

Filling out the Pormularyo is a vital step in reporting fraud related to health insurance sales. This guide will provide you with clear, step-by-step instructions to help you complete the form efficiently and accurately.

Follow the steps to successfully complete the Pormularyo.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing details about your complaint. Answer the questions, such as what was offered to you by the company, and whether you received the offer by selecting 'yes' or 'no.'
3. Indicate if you believe the company made false statements. If so, provide specific details regarding the statements you believe were incorrect.
4. State whether you made any payments to the company. If you did, include the amount paid and the payment method you used.
5. Specify the date when the company first contacted you using the date format provided (MM/DD/YYYY).
6. Detail your initial response to the company upon contact.
7. Select how the company contacted you (e.g., phone, email, in person) and provide a description if you choose 'advertisement' or 'other.'
8. Indicate if you signed any documents from the company and if you provided any personal or financial information to them.
9. List any other agencies or entities that have contacted you for assistance regarding your complaint.
10. Describe what you wish, need, or expect to resolve your complaint.
11. Add any additional information about your experience, including details about the company and what was offered.
12. Complete your contact information, ensuring to include your name, address, phone numbers, and email. This is essential for the department to reach you if needed.
13. Provide information about the company involved in your complaint, including its name, address, phone number, and any representatives you interacted with.
14. If you have any documents relevant to your case, make sure to mention that you will attach copies with your submission.
15. Review the instructions for submitting the form, either by faxing or mailing it to the designated Help Center address.
16. Finalize by signing the form with the appropriate date.
17. Save your changes, and ensure you have downloaded or printed a copy of the form for your records.

Complete your Pormularyo online to take an important step in addressing your health insurance fraud concerns.