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9 Medical Insurance Forms to Streamline Your Insurance Processes

Medical emergencies are a stressful time for patients. 

If the initial shock wasn’t enough, they also have to navigate the confusing world of medical insurance claims and forms. It’s a tough task, but you can help make it easier with comprehensive medical insurance forms.

A medical insurance form is a document that patients complete to file claims or receive reimbursements. These forms help healthcare providers and insurers to settle claims and assist patients with medical bills—making the process a little less intimidating. 

Read on for the top nine medical insurance templates from 123FormBuilder to help you and your patients streamline medical insurance inquiries and stay on top of insurance claim management.  

Let’s get started.

1. Dental Insurance Breakdown Form Template

dental insurance breakdown form

Who needs this? 

This is a must-have medical form for dental offices. If you run a dental care facility, you can use this form to share details on any dental procedures and include insurance coverage details.

What’s it for? 

This dental insurance breakdown form helps you capture insurance information, dental treatment plan details, and even third-party claim details. You can use the coverage details to claim dental work expenses, depending on the type of plan (preventative, major, periodontal, etc.) a patient has. 

Key benefits:

  • Easy to use and setup: make a great first impression with this easy-to-customize dental insurance form that patients can submit anytime, anywhere.
  • Paper-free: reduce environmental impact and office clutter, and streamline information sharing with these electronic forms
  • Automated email notification: keep your team in the loop with email notifications as patients fill in and submit forms. 

2. Dental Insurance Form Template

dental insurance form

Who needs this? 

This dental insurance form is for dental practices looking to digitize and optimize internal processes and workflows. Dental clinics with manual bookkeeping practices will benefit from this form as well. 

This form helps you to send patient and treatment information to the insurance company instantly and receive payments faster. 

What’s it for? 

Dental offices use this dental insurance form to record claims data, policyholder information, patient details, and more. This form helps you digitize bookkeeping and streamline how you share information with insurance companies. 

Key benefits:

  • Upload field: add images and documents to the form to shed more light on the diagnosis and treatment. 
  • Automated notifications: configure alerts so that your billing team receives real-time emails for every form submission.
  • Custom integrations: connect and sync data with third-party applications to do more with the data you collect.

3. Dental Insurance Verification Form Template

dental insurance verification form

Who needs this? 

Treatment coordinators or front office executives at dental care facilities use this insurance verification form to request patients’ insurance information. This form comes in handy especially when you want to confirm insurance provision for treatments such as scaling, root planing, preventive visits, and sealants. 

What’s it for? 

Verification forms help dental clinics stay on top of patient insurance information. For example, does their insurance cover fluoride varnish applications? 

When you offer the treatment without the full picture, you may miss out on important information that causes payment issues further down the line. 

Key benefits:

  • Conditional logic flow: personalize the patient experience based on previous answers. For example, if an insurance plan doesn’t cover fluoride varnish treatments, there’s no point in asking more questions on the same. 
  • Error-free data: prevent document loss or damage with these online forms, and have dental insurance data at your fingertips.
  • Easy to access: make patients’ life easier with digital forms that they can access and fill in from anywhere.

4. Health Insurance Claim Form Template

health insurance claim form

Who needs this? 

This health insurance claim form is for healthcare organizations looking to record patient information and simplify processes at their facilities. These forms offer patients a quick and easy way to make a claim to their medical insurance provider for the care they’ve received at your facility. 

What’s it for? 

Patients use health insurance claims to request medical expense coverage from insurance providers. The law requires a patient to fill in the form before the treatment begins at a healthcare facility. 

As a healthcare service provider, you can make life easier for patients by offering customized health insurance claim forms that meet insurance companies’ requirements. 

Key benefits:

  • Improve productivity: digital forms help you to speed up the insurance claim process for both you and your patients.
  • Stay compliant: keep patient information and diagnosis plans confidential, and ensure you’re regulation compliant with the Enterprise plan that features a HIPAA-compliant form tool.
  • Seamless integration: connect your existing systems with 123FormBuilder to maintain data consistency and boost efficiency.

5. Health Insurance Evaluation Survey Form Template

health insurance evaluation survey

Who needs this? 

This survey form helps health insurance companies collect feedback from patients. If you work for an insurance provider, you’ll use this form to capture data for future improvements. 

What’s it for? 

Insurance companies are keen to know whether patients find their services beneficial or not—happy customers are typically retained, after all. 

These companies use health insurance evaluation questionnaires to gather feedback on ease of claim submission, availability of doctors, and overall satisfaction with insurance plans. This feedback helps insurance providers bridge gaps between patient expectations and existing solutions.

Key benefits:

  • Paper-free: collect feedback that you can access from anywhere. Paperless forms reduce your carbon footprint and help you build a sustainable workplace.
  • Easy to use: patients prefer forms that they can easily fill in and access from any device. 
  • Fully customizable: insurance providers may want to change questions depending on the patient demographics. Easy customization helps create different forms effortlessly.

6. Health Insurance Information Form Template

health insurance information

Who needs this? 

Insurance companies use health insurance information forms to collect income, insurance, and family-related information from patients. If you run a health insurance company, you’ll need this form when signing people up for insurance plans. 

What’s it for? 

Health insurance providers verify patients’ Medicare enrollment, employer insurance assistance, and gross household income to decide whether an individual’s eligible to receive insurance. This form helps insurance companies collect all the necessary data points and make decisions accordingly.

Key benefits:

  • Integrate with existing tools: integrate 123FormBuilder with your existing workflow to streamline the entire process. 
  • Conditional logic: create different questions depending on a patient’s answer to the previous question. If they’re unmarried, there’s no need to ask for a spouses’ details.
  • Thank you page:  create a customized Thank You page to show your appreciation to patients for filling out the form. 

7. Health Insurance Marketplace Statement Form Template

health insurance marketplace statement

Who needs this? 

The Health Insurance Exchange uses health insurance marketplace statement forms to collect and store health insurance policyholder information. This policyholder data usually includes policy start date, termination date, address, and premium amount.

What’s it for? 

Insurance providers use health insurance marketplace statement forms to verify marketplace coverage information and create annual statements. These statements reflect key policy details that patients can benefit from when taking out medical insurance. 

Key benefits:

  • Real-time notifications: use email notifications to quickly notify relevant team members of form completion.
  • Secure data: keep policyholder data secure and ensure HIPAA compliance with 123FormBuilder’s Enterprise plan.
  • Fully customizable: include additional text fields and dates for form functionality, and even include your logo and branding for a seamless experience. 

8. Medical Insurance Form Template

medical insurance form template

Who needs this? 

If you’re an insurance company, this is one of the most important forms you need at your disposal. It’ll help you collect information from individuals willing to apply for insurance coverage. This application can be for new memberships or upgrading existing ones.

What’s it for? 

Medical insurance forms help insurance providers collect relevant data from individuals looking to take out medical insurance. Individuals can mention the type of care they’re applying for along with medical history and employment details. 

Key benefits

  • Secure and online: online forms are more secure and easier to manage. Plus, they’re better for the environment—enabling you to cut down your carbon footprint.
  • Improve efficiency: rely on online forms for effortless data collection, and save valuable time. It takes zero coding to create one from scratch.

9. Student Insurance Claim Form Template

student insurance claim form

Who needs this? 

Students use this form to submit insurance claims for accident or injury treatment expenses. They can also use the same form to request reimbursements for expenses paid out of pocket. 

What’s it for? 

Student insurance claim forms help insurance companies verify medical emergencies with the healthcare service provider and process reimbursements or claims. 

Key benefits:

  • Upload field: add any important files that could help speed the process up, such as scans and prescriptions.
  • Custom fields: use our free online form builder to add custom fields and make the claim submission process as seamless as possible for students.
  • Paper-free: make the insurance claim form accessible online so that students don’t have to wait for a paper document before the treatment starts. 

Medical Insurance Forms are Easier to Manage with 123FormBuilder

If you’re a healthcare service provider or an insurance company, insurance forms are just one of the many forms you need on hand. Whether you’re managing claims or verifying insurance details—online forms are a must for efficient, secure medical insurance management. 

123FormBuilder makes creating, sharing, and managing forms of all types effortless. You can also leverage ample integration options to connect existing systems and streamline your internal processes. 123FormBuilder’s Enterprise Plan even features HIPAA-compliant forms to ensure you never have to worry about regulation and patient information confidentiality again. 

Sign up today and start using 123FormBuilder to easily create and manage your key forms, surveys, questionnaires, and more. Whether you’re a hospital, clinic, surgery, or insurance provider—123FormBuilder’s medical form templates are a great way to improve your data collection methods and speed up your processes.


Medical Insurance Forms: Frequently Asked Questions

What forms are used for medical billing?

Medical billing uses two types of forms:

  1. UB-04 or CMS-1450: for manual claim submissions
  2. 837-I: for electronic claim submissions

Patients can use these two forms to submit medical expense claims. 

What are considered medical expenses?

Medical expenses are costs incurred from injury or disease treatment and preventive healthcare. Insurances typically cover the following medical expenses:

  • Health expenses
  • Dental expenses
  • Doctor and hospital visits
  • Co-pays
  • Prescription and over-the-counter (OTC) drugs
  • Glasses and contacts
  • Crutches
  • Wheelchairs

Patients with medical insurance can expect support from their insurance provider when encountering any of these issues. 

What is not considered a qualified medical expense?

The following medical expenses are not considered to be qualified for claim submissions:

  • Nonprescription drugs
  • General health programs (weight loss treatment, health club fees, etc.)
  • Doctor-prescribed traveling for relaxation and self-healing

In these cases, patients shouldn’t expect support from their insurance provider.

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