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Get the free Kentucky Employees’ Health Plan 2012 Certification of Dependent Eligibility - ktrs ky

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This document is used to certify the dependency of children ages 19 through 25 for eligibility under the Kentucky Employees’ Health Plan.
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How to fill out Kentucky Employees’ Health Plan 2012 Certification of Dependent Eligibility

01
Obtain the Kentucky Employees' Health Plan 2012 Certification of Dependent Eligibility form from your HR department or the plan website.
02
Read the instructions carefully to understand the eligibility requirements for dependents.
03
Fill out the personal information section, including your name, employee ID, and contact information.
04
List all dependents you wish to certify, including their names, dates of birth, and relationship to you.
05
Provide documentation to verify the eligibility of each dependent, such as a birth certificate, marriage certificate, or adoption papers.
06
Review the completed form for accuracy and completeness.
07
Sign and date the form to certify that all information is correct.
08
Submit the form and supporting documents to the appropriate HR representative or as directed.

Who needs Kentucky Employees’ Health Plan 2012 Certification of Dependent Eligibility?

01
Employees of the Kentucky Employees' Health Plan who have dependents they wish to include in their health coverage.
02
Employees who are enrolling new dependents or making updates to their dependent information.
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It is a document required to verify the eligibility of dependents enrolled in the Kentucky Employees’ Health Plan, ensuring that only eligible family members are covered under the plan.
All employees participating in the Kentucky Employees’ Health Plan who have dependents enrolled in the plan must complete and submit this certification.
To fill it out, gather necessary documentation proving the dependent's eligibility, complete the required information on the form, sign it, and submit it to the designated human resources department.
The purpose is to ensure compliance with eligibility requirements, prevent fraud, and confirm that only eligible dependents receive health care benefits.
The report must include the employee's information, the dependent's details such as name, relationship, date of birth, and any relevant documentation that supports the dependent's eligibility.
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