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Local 731, I.B. of T. Welfare Fund 1000 Burr Ridge Parkway Suite 301 Burr Ridge IL 60527 Telephone: 6308874150 Extended Dependent Coverage Form This form must be completed and returned with required
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How to fill out extended dependent coverage form

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How to fill out extended dependent coverage form?

01
Start by carefully reading the instructions provided with the form. Make sure you understand the purpose and requirements of the extended dependent coverage form.
02
Gather all the necessary information needed to complete the form. This may include personal information of the dependent(s) such as name, date of birth, social security number, and relationship to the policyholder.
03
Fill out the personal details section of the form accurately. Double-check the information entered to avoid any mistakes or discrepancies.
04
If required, provide details about the policyholder's insurance coverage. This may include the policy number, the type of coverage, and any additional information requested.
05
Review the section regarding the dependent's eligibility for extended coverage. This may include verifying their age, student status, or other qualifications mentioned in the form.
06
Sign and date the form at the designated areas. Ensure that you have completed all the necessary fields before signing.
07
Submit the completed extended dependent coverage form according to the instructions provided. It may be recommended to retain a copy of the filled form for your own records.

Who needs extended dependent coverage form?

01
Employees or policyholders who wish to extend their health insurance coverage to dependents who may not be covered otherwise.
02
Individuals who have dependents not meeting the standard eligibility criteria defined by the insurance policy.
03
Individuals who have dependents that may be eligible for coverage under certain circumstances, such as children above the usual age limit, disabled dependents, or divorced spouses.
Note: It is always advisable to consult with your insurance provider or the relevant HR department to determine if the extended dependent coverage form is necessary in your specific situation.
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Extended dependent coverage form is a form used to provide additional information about dependents that are covered under a health insurance policy.
The policyholder or primary insured individual is required to file the extended dependent coverage form.
The extended dependent coverage form can usually be filled out online or by submitting a paper form with the required information about the dependents.
The purpose of the extended dependent coverage form is to ensure that accurate information about dependents is provided to the insurance company for coverage purposes.
The extended dependent coverage form typically requires information such as the dependent's name, date of birth, relationship to the insured, and any other relevant details.
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