Get the free PORTABILITY REQUEST FORM - Shalom House - shalomhouseinc

PORTABILITY REQUEST FORM The initial LAW is responsible for filling out both the Initial LAW portion and the Receiving LAW portion. Once complete the initial LAW will send via email, mail or secure

How to fill out portability request form

How to fill out a portability request form:

1. Start by reviewing the instructions: Read the instructions carefully before filling out the form. This will help you understand the requirements and ensure that you provide all the necessary information.
2. Provide your personal information: The form will usually ask for your full name, address, contact details, and other identifying information. Fill in these fields accurately and legibly.
3. Specify the reason for the request: Indicate why you are requesting portability. This could be due to changing jobs, relocating, or any other valid reason for transferring your benefits.
4. Provide details about your current plan: You may be required to provide information about your current healthcare plan, such as the insurance company or provider, policy number, and effective dates. Make sure to include this information accurately.
5. Select the new plan: If you already have a new plan in mind, indicate the details of that plan, such as the insurance company or provider, policy number, and effective dates. If you are still in the process of selecting a new plan, leave this section blank.
6. Attach supporting documents: Depending on the requirements, you may need to attach supporting documents to your portability request form. This could include documents like proof of employment termination, proof of new employment, or any other documents that may validate your request.
7. Sign and date the form: Before submitting the form, make sure to sign and date it. This verifies that the information provided is accurate to the best of your knowledge.

Who needs a portability request form:

1. Employees changing jobs: If you are switching employers and want to transfer your healthcare benefits from your current plan to a new employer-sponsored plan, you will typically need to fill out a portability request form.
2. Individuals relocating: If you are moving to a new location and wish to transfer your healthcare benefits to a new plan available in your new area, you may need to submit a portability request form.
3. Dependents of policyholders: In some cases, dependents of policyholders, such as spouses or children, may need to fill out a portability request form to transfer their coverage when the primary policyholder experiences a qualifying event.

Remember, the specific requirements for a portability request form may vary depending on the insurance provider and the circumstances. It is always advisable to consult the instructions provided and contact the relevant authority or insurance company if you have any specific questions or concerns about filling out the form.

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