We're going to be going over how a health insurance claim form should look when you submit it to insurance to get reimbursed. YOU ARE AUTHORIZED TO PROVIDE THIS INFORMATION IN ACCORDANCE WITH THE NEW YORK COMPREHENSIVE MOTOR VEHICLE INSURANCE REPARATIONS ACT (NO-FAULT LAW).PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE I authorize the release of any medical or other information necessary to process this claim. Find all available forms including authorization forms, claim forms and more. Health Insurance Claim Form - EmblemHealth, HIP, GHI. You are invited to participate in a research study. The purpose of this research is to study an alternative way to close an abdominal wound. DSS will mail you a letter if you need to complete a renewal form. Complete the renewal form. If you don't have that, fill out this form.