The following forms relating to Medical Support are available:
- National Medical Support Notice - Part A (sample)
- Employer Response (Part A) – Form to use when responding to Part A by fax or mail
- Instructions to Employer (Part A)
- National Medical Support Notice to Administrator - Part B (sample)
- Plan Administrator Response (Part B) – Form to use when insurance is available and responding to Part B by fax or mail
- Instructions to Plan Administrator (Part B)
- Employer Health Insurance Enrollment – Form to use to provide enrollment information for dependent children by fax or mail
- Health Insurance Status Change – Form to use when lapse in health insurance coverage or when an employee terminates employment by mail or fax
- Other Source Health Insurance Information – Form to use to notify OAG when dependent children are enrolled in another source health insurance plan.
- Employer Authorization for Third-Party Reporting (OAG Form 1840)– Form to use when the employer hires a Third-Party Agent to handle the health insurance on behalf of the employer.
- Revocation for Third-Party Reporting (OAG Form 1841)– Form to use to notify the OAG when the Third-Party Agent is no longer handling health insurance for the employer.