LDSS-4703. Health Care Plan Legally-Exempt Group Child Care Program

Form LDSS-4703, Health Care Plan Legally-Exempt Group Child Care Program, is a NYS Office of Children and Family Services form that is used to document the health care plan of a legally-exempt group child care program.

This form consists of three main sections. The first section includes the name and contact information of the legally-exempt group child care program. The second section includes questions related to the health care plan of the program such as the type of health care plan, the name of the insurer, the policy number, and any additional information about the health care plan. The third section includes questions about the health care coverage of the program, such as the duration of the coverage, the number of children covered, and the type of health care services covered. This form must be signed and dated by the responsible person of the program.

Important fields in this form include the name of the legally-exempt group child care program, the name of the insurer, the policy number, the duration of the coverage, the number of children covered, and the type of health care services covered. It is important to make sure that all of the information on this form is accurate and complete, as this form is used to verify that the legally-exempt group child care program has a valid health care plan.

This form would be used by a legally-exempt group child care program to document its health care plan. The benefits of using this form are that it allows the program to demonstrate that it is compliant with the health care requirements for legally-exempt group child care programs. Specific instructions for filling out this form include making sure that all sections are filled out completely and accurately, and that all information is legible. Related forms and alternatives include the LDSS-4701, Group Family Day Care Health Care Plan, which is used to document the health care plan of a group family day care program.