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R43768 Complete only if Presently Insured by Blue Cross and Blue Shield of Florida, Inc. or Health Options, Inc. CHANGES MUST BE MADE WITHIN DEFINED ELIGIBILITY PERIOD. Member Status Change Request

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What is member status change request?

Member status change request is a form used to update information about a member's status within an organization.

Who is required to file member status change request?

Any member or representative of an organization is required to file a member status change request if there are any changes in the member's status.

How to fill out member status change request?

To fill out a member status change request, one must provide the necessary information such as member's name, old status, new status, reason for change, and any supporting documentation.

What is the purpose of member status change request?

The purpose of member status change request is to ensure that the organization has up-to-date information about its members and their status within the organization.

What information must be reported on member status change request?

The member status change request must include the member's name, old status, new status, reason for change, and any supporting documentation.

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