Get the free CONTINUATION PLAN ENROLLMENT CARD

UNIVERSITY OF CHICAGO CONTINUATION PLAN ENROLLMENT CARD UnitedHealthcare INSURANCE COMPANY 2011-451-2 (PLEASE PRINT) Student s Name / / Last First MI Male Female Permanent US Address Street or PO

How to fill out continuation plan enrollment card

How to fill out a continuation plan enrollment card:

1. Start by obtaining the enrollment card from your employer or insurance provider. This card is typically given to individuals who are eligible for continuance of their health insurance coverage.
2. Carefully read the instructions provided on the card. Make sure you understand the information required and any specific guidelines mentioned.
3. Begin by filling out your personal information accurately. This typically includes your full name, date of birth, address, and contact details. Ensure that the information is legible and up-to-date.
4. Provide your social security number or any other identification number specified on the card. This is essential for verifying your eligibility and ensuring that your coverage continues seamlessly.
5. If applicable, include the names and information of any dependents who are also eligible for continuation of coverage. This may include your spouse, children, or any other relevant individuals.
6. Indicate the type of plan you are enrolling in or seeking to continue. This could be a specific health insurance plan, dental coverage, or any other benefits offered by your employer or insurance provider.
7. Review the card thoroughly to ensure that all the required information has been completed accurately. Double-check for any missing fields or errors that may cause issues with the enrollment process.
8. Once you are confident that all the necessary information has been provided, sign and date the enrollment card. Your signature signifies your consent and agreement to the terms and conditions of the continuation plan.

Who needs a continuation plan enrollment card:

1. Individuals who are experiencing a qualifying event that triggers the need for continuation of their health insurance coverage typically require a continuation plan enrollment card.
2. Qualifying events may include the loss of a job, divorce, legal separation, reduction in work hours, or the death of a spouse or parent who maintained the insurance coverage.
3. The continuation plan enrollment card is important for those individuals who wish to continue their health insurance coverage for a limited period of time after the occurrence of a qualifying event.
4. It ensures that individuals and their dependents have access to necessary healthcare services and coverage during times of transition or unforeseen circumstances.

In conclusion, filling out a continuation plan enrollment card involves providing accurate personal information, including any dependents, specifying the plan you are enrolling in, and signing the card. This card is necessary for individuals who are eligible for continuation of their health insurance coverage after experiencing a qualifying event.

For pdfFiller’s FAQs

What is continuation plan enrollment card?

The continuation plan enrollment card is a form that allows individuals to enroll or renew their participation in a continuation plan.

Who is required to file continuation plan enrollment card?

Individuals who are eligible for a continuation plan are required to file the enrollment card.

How to fill out continuation plan enrollment card?

To fill out the continuation plan enrollment card, individuals must provide their personal information, select their plan options, and sign the form.

What is the purpose of continuation plan enrollment card?

The purpose of the continuation plan enrollment card is to ensure that individuals have access to continued coverage under a health plan.

What information must be reported on continuation plan enrollment card?

The continuation plan enrollment card must include personal information such as name, address, contact information, and plan selections.

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