Get the free Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN
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This document is used to certify the eligibility of a dependent child for health coverage under the group health plan, specifically for young adult children up to age 26, as mandated by the Patient
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How to fill out certification of qualified dependent
How to fill out Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN
01
Obtain the Certification of Qualified Dependent Status form from WellSpan Health Plan's website or office.
02
Fill out the dependent's personal information, including full name, date of birth, and relationship to the primary member.
03
Provide the primary member's information, including name, member ID, and contact details.
04
Attach required documentation to prove dependent status, such as birth certificates, marriage certificates, or legal guardianship documents.
05
Sign and date the form to certify the information provided is accurate.
06
Submit the completed form and attachments to WellSpan Health Plan via mail, email, or fax as directed on the form.
Who needs Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN?
01
Any primary member of the WellSpan Health Plan who wishes to enroll or verify the dependent status of their eligible dependents, including children or spouses.
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What is Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN?
The Certification of Qualified Dependent Status is a document utilized by WellSpan Health Plan to verify the eligibility of dependents for health coverage under the plan.
Who is required to file Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN?
Employees or members who wish to enroll or confirm the eligibility of their dependents under the WellSpan Health Plan are required to file this certification.
How to fill out Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN?
To fill out the certification, individuals must provide required information such as their personal details, details of the dependents, and supporting documentation as required by WellSpan Health Plan.
What is the purpose of Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN?
The purpose of the certification is to ensure that only eligible dependents are covered under the health plan and to maintain compliance with plan guidelines.
What information must be reported on Certification of Qualified Dependent Status – WELLSPAN HEALTH PLAN?
The certification must report information including the names, relationships, and dates of birth of the dependents, along with any necessary verification documents to support eligibility.
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