Print and then fill out the Insurer request Certification Form that follows. You can download our Complaint Form.This form (2 pages) is used to request a Certificate of Insurance from an Assigned Risk Pool Carrier. To download the form you need, follow the links below. Here's some information on how to submit original claims to us. How do I fill this out? Form 1099-HC is needed to complete your MA state tax return. You must submit your external review request form to OPP within 4 months of receiving your final adverse determination letter. Find online forms and Medicare documents here, including reimbursement forms, summary of benefits, designation of representative. For Federal Employee Program members, submit claims with a single letter "R" and the member ID number.