Form 8848 AR 2017-2025

Form 8848 AR: What You Should Know

We want to ensure that there is no fraud or abuse. We do not use this information to make assessments on your potential premium. Each county has their own eligibility requirements as outlined by the Arkansas Insurance Commissioner. REPORT BY JOURNALIST OR OTHER NOTES ON CERTAIN ELEMENTS OF FORM 8848 This is information that should not be included in the application form. We will only look at that information if the form needs it to do anything related to the application. You must write one of the following words in the space provided for the date. . No, you do not have to write any of these words. SOLICITATIONS for the following organizations are required to use form 8848 for: Organizations can fill out the form electronically. They can also complete the form on paper but will need to submit a paper copy of form 8848. FOR EMPLOYEES OF ORGANIZATIONS COVERED by the Arkansas Insurance Commissioner's regulations and orders The following organizations can not fill out the form electronically. Employees and officers cannot use electronic filing systems such as filing or the electronic application service provided by the Insurance Commissioner's office. You must submit the form by paper. Forms must be submitted in accordance with the rules and requirements on the forms' website: The following groups of employers with no Arkansas employees or officers may not fill out the form electronically: Organizations that are eligible to apply for or receive ARK for their part-time employees and paid by EFT The following organizations may fill out the form electronically but may be sent only a paper copy. Employees and officers may use their electronic forms to check their eligibility for Medicaid and to sign and submit the form; Employees and officers can check their eligibility for ARK for pay in Arkansas by printing, signing and returning this form. Once a customer signs up for Medicaid/Arkansas Works, that company must submit a paper copy of the form to the insurance commissioner's office. This form becomes a record that you are claiming Medicaid and ARK. It may be used to provide documentation that you have qualified or applied for Medicaid and ARK, your state income tax payments and other necessary information. It MUST be filed when required by the insurance commissioner within 2 years of its submission. To obtain information on Medicaid, Ark. Health Plan, other health plan or health insurance that the insurance commissioner can use to verify income.

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