Important Forms

Reimburse the State

If you are injured as the result of an auto accident or other mishap caused by another person, your medical expenses will usually be covered by that person (often his or her auto or property insurance company). However, your immediate medical expenses will be covered by the State Health Plan while you wait for the other person to pay your expenses. Once you receive money from the other person, use the Overpayment form below to reimburse the State Health Plan for charges already paid.

Overpayment Form
Use this form to repay the State Health Plan if your medical expenses are paid for by both a third party and the State Health Plan. Such duplicate payments typically occur as a result of incidents such as auto accidents in which a third party is liable for your health expenses.

Authorization Form
Use this form to authorize someone else, such as a relative or attorney, to file claims on your behalf.

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