Health Insurance Continuation Program (HICP) Health Insurance Information
Form Template
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This form authorizes future premium notices to be sent to the New Jersey Department of Health HICP. Captures all the required information including type of insurance coverage, the employer or union providing insurance coverage, name of other individuals covered by the policy, and more. Please note that the HICP must have your original premium notices from your insurance company before they can begin making your insurance payments.
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