Streamlined Webform for Evaluating Local Health Departments Premiums
We're excited to introduce our webform for the third year! We have made a few changes to what information is needed to get an accurate assessment of risk from the insurance carrier. Please fill out all sections no later than February 28th. For purposes of defining a visit, if a person receives multiple services on the same day, such as an exam, lab, and vaccines, it should be counted as one unduplicated visit. If a patient is seen on different dates, it should be counted as multiple visits. For example, a patient who is seen on Monday for an exam and Thursday for labs should be counted as two visits.
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Primary care appointments
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STD/STI testing and treatment
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Immunization appointments
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Family planning/contraceptive visits
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​TB testing and follow-up visits
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Telehealth/Telemedicine
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Behavioral health sessions
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School-based clinic encounters
Contact Us:
If you have any questions or need assistance, please don't hesitate to contact us.
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