Form 11318 PDF Details

Today the IRS released a new Form, 11318, which will be used to report information about Controlled Foreign Corporations (CFCs). This new form is in response to the recent changes made by the Tax Cuts and Jobs Act, and it is meant to provide more transparency about CFCs and their operations. The new form will require taxpayers to provide detailed information about their CFCs, including their income, taxes paid, and shareholders. This information will help the IRS better understand how CFCs are affecting the US economy, and it will allow them to make more informed policy decisions going forward. businesses should familiarize themselves with this new form and make sure they are filing it correctly. Failing to do so could result in stiff penalties from the IRS.

Form NameForm 11318
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesshp_claim state health plan comprehensive benefits claim form

Form Preview Example

state health plan benefits claim form

South Carolina Public Employee Benefit Authority (PEBA)

You must attach copies of itemized bills (including diagnoses, date(s) service(s) received, procedure codes,

provider name, and provider identification number(s)) to receive proper payment for your claim.


Insured’s Name












































Patient’s Name























Middle Initial

































The patient is:



























The patient is the:





















Insured’s Spouse




Insured’s Child




















Patient’s Date of Birth









































5Mailing Address
















ZIP Code
















6 Was the treatment required as a result of accidental injury?




If yes, give date of accident





















































medicare information


















Is the patient covered by Medicare?



If yes, give date of Medicare No.




















If yes, does the patient have Medicare Part A (Hospital Benefits)?













Date coverage became effective _____/ ____/ ____















7If yes, does the patient have Medicare Part B (Medical Surgical Benefits)?



Date coverage became effective ____/ ____/ ____














Is patient entitled to Medicare because of ESRD?




Is patient actively working?










Is the patient disabled?












Is the patient retired?


















If yes, give the date of retirement

____/ ____/ ____

other group insurance coverage

Is the patient covered under any other health benefit plan?



if yes, you must complete this section so your claims can be processed.

A. Name of other insurance company


Address of other insurance company

B.Name of insured under this policy (policyholder) Relationship to patient

Insured’s date of birth

C.Effective date of other insurance policy Policy number of other insurance policy

Always attach your Explanation of Beneits or explanation of payment from your other plan.



certification of member





I certify that the above information is correct and that the foregoing expenses were incurred for the above-named patient.

I authorize any physician, nurse, hospital or other provider or supplier in possession of records or information concerning the patient to



furnish such information to BlueCross BlueShield of South Carolina upon request.


















(11318) Rev. 3/13

Please see the other side of this form for mailing instructions.




please send this form to:

BlueCross BlueShield of South Carolina

P.O. Box 100605

Columbia, SC 29260-0605

In Columbia: 803-736-1576

In S.C. and Nationwide: 800-868-2520

before you mail your claim form, please remember to:

1.include the insured’s bin – beneits identiication number (the id number on your state health plan card);

2.sign and date the form; and

3.attach copies of itemized bills for services, including:


date(s) service(s) received,

procedure codes,

provider name, and

provider identiication number(s).

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

How to Edit Form 11318 Online for Free

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Step 1: Press the orange "Get Form" button above. It is going to open up our tool so that you can start completing your form.

Step 2: The editor lets you change nearly all PDF documents in various ways. Enhance it with customized text, correct existing content, and place in a signature - all close at hand!

This form requires specific details; to guarantee consistency, you need to take into account the suggestions just below:

1. Fill out your Form 11318 with a selection of necessary blank fields. Collect all of the information you need and ensure there's nothing forgotten!

The best ways to fill in Form 11318 portion 1

2. Right after finishing this part, go to the next stage and complete the necessary details in these blank fields - M Yes M No, Date coverage became effective, Is patient entitled to Medicare, Is patient actively working, Is the patient disabled, Is the patient retired, M Yes, M Yes, M Yes, M Yes, M No, M No, M No, M No, and If yes give the date of retirement.

Filling out section 2 in Form 11318

3. Completing INSUREDS SIGNATURE, DATE, Rev, and Please see the other side of this is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Form 11318 completion process outlined (part 3)

Always be extremely careful while completing DATE and Please see the other side of this, as this is where many people make errors.

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