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1515 North Saint Joseph Avenue PO Box 8000 Marsh field, WI 544498000 1.800.472.2363 715.221.9555 Policy Extension for Dependent Application Subscriber name Subscriber no. Dependent name Dependents
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How to fill out policy extension for dependent
How to fill out policy extension for dependent:
01
Fill out the necessary personal information of the dependent, such as their full name, date of birth, and relationship to the policyholder.
02
Provide the required details regarding the dependent's medical history, including any pre-existing conditions or ongoing treatments.
03
Indicate the specific coverage or benefits that the policy extension should apply to the dependent, such as medical expenses, dental care, or vision services.
04
Review and sign the policy extension form, ensuring that all information provided is accurate and complete.
Who needs policy extension for dependent:
01
Individuals who have dependent family members, such as a spouse or children, may need a policy extension to include them in their insurance coverage.
02
Policyholders who wish to extend their existing policy benefits to cover their dependents' healthcare needs would also require a policy extension.
03
Employers who offer group insurance plans may need to facilitate policy extensions for employees who want to add their dependents to the coverage.
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What is policy extension for dependent?
Policy extension for dependent is a process where an existing policyholder adds coverage for their dependents under the same insurance plan.
Who is required to file policy extension for dependent?
The policyholder or primary insurance holder is required to file policy extension for their dependents.
How to fill out policy extension for dependent?
Policy extension for dependent can be filled out online through the insurance company's website or by contacting their customer service.
What is the purpose of policy extension for dependent?
The purpose of policy extension for dependent is to provide insurance coverage for the dependents of the policyholder.
What information must be reported on policy extension for dependent?
The policy extension for dependent may require information such as the dependent's full name, date of birth, and relationship to the policyholder.
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