Find benefit summaries, formularies (list of covered drugs), and all necessary forms to get the most out of your EmblemHealth coverage. This application can be used to apply for Medicaid, the.Family Planning Benefit Program, or for assistance paying your health insurance premiums. Insured's ID Number. (Patient's Medicare Health Insurance Claim Number - HICN). UP offers the following customizable sample letters and examples of loss and claim-related documents for use in navigating your insurance claims. These sample letters can be used in various circumstances you may encounter that require you to communicate with insurance companies. Find health insurance forms for customers including medical and dental claims forms, authorization forms, appeals, pharmacy forms, and more. Complete the forms with the following tips in mind: ô€€€ Type or print all information. Entries should be in black ink.