Health Republic Insurance of New York
Liquidation Administration Website

Liquidation Closing Page

Welcome to the Health Republic Insurance of New York, Corp. (Health Republic) closing page. Here you will find the forms and information you need to receive a distribution on an allowed claim in the Health Republic liquidation. All creditors are required to submit a Policyholder Address Verification Form or a Form W-9 in order to receive a distribution.


  • If you are a person who was a former policyholder of Health Republic, click here to submit a Policyholder Address Verification Form.

      * If your address has changed since the date of liquidation (May 11, 2016), check the “change of address” box and submit the required proof of change of address.

  • All other creditors, click here to submit a Form W-9.

      * If your address has changed since the date of liquidation (May 11, 2016), check the “change of address” box and submit the required proof of change of address.

  • For more information on the Health Republic Closing Plan, click on the following topics:


Information on the Health Republic Closing Plan.

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Why do I need to submit a form to receive a distribution?

The Liquidator requires all creditors to submit a completed Policyholder Address Verification Form or a Form W-9 to ensure that distribution checks are sent to correct mailing addresses and to comply with the Liquidator’s tax reporting obligations. The Liquidator will only send distribution checks to creditors that have verified their information by submitting the requisite forms. For further information, please see the links below:

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How do I determine which form to file?

Any person who was a former policyholder of Health Republic with an allowed claim is required to submit a completed Policyholder Address Verification Form. All other creditors of Health Republic with allowed claims are required to submit a completed Form W-9. For further information, see the documents below:

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I would like to read the instructions for completing the Form W-9.

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What happens if I do not submit a Policyholder Address Verification Form or Form W-9?

Creditors who do not submit a Policyholder Address Verification Form or Form W-9, or whose information cannot be validated by the time the Liquidator files a closing report with the court supervising the liquidation proceeding will not receive a distribution. Such distributions will be placed in a segregated account pending closure of the estate, and thereafter handled in accordance with New York Abandoned Property Law.

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I would like to confirm the total amount of my allowed claim.

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I have other questions and would like further assistance.

If you have other questions, please submit an online inquiry.

If you require technical assistance, please call our technical support call center at (866) 680-0893.

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