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Date of Qualifying Event: County of Hamilton Qualifying Event Reason: 2015 Qualifying Event Form A. Employee General Information: First Name: Employee ID: Last Name: Department #: Home Phone: () —

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What is qualifying event form?

The qualifying event form is a document used to report any events that may affect your eligibility for benefits or coverage under a health insurance plan.

Who is required to file qualifying event form?

Anyone who experiences a qualifying event, such as a change in family status or loss of other coverage, is required to file a qualifying event form with their insurance provider.

How to fill out qualifying event form?

To fill out a qualifying event form, you will need to provide information about the event that occurred and any supporting documentation, such as marriage certificates or loss of coverage letters.

What is the purpose of qualifying event form?

The purpose of the qualifying event form is to notify your insurance provider of any changes that may impact your coverage, so they can make the necessary adjustments to your policy.

What information must be reported on qualifying event form?

The information that must be reported on a qualifying event form includes details about the event that occurred, the date it happened, and any relevant documentation.

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