Get the free New Enrollee – Continuity of Care Form

A form for new enrollees to ensure continuity of care while transitioning to a new healthcare provider, requiring detailed information about ongoing treatments, appointments, and medical history.

How to fill out new enrollee continuity of

How to fill out New Enrollee – Continuity of Care Form

1. Gather your personal information: full name, date of birth, and contact details.
2. Provide your insurance information including policy number and provider details.
3. Indicate the reason for enrolling in continuity of care.
4. List your current healthcare providers: names, specialties, and contact information.
5. Specify any ongoing treatments or medications you are receiving.
6. Check any applicable boxes or sections related to your health history.
7. Review the form for accuracy and completeness.
8. Sign and date the form to confirm the information is correct.

Who needs New Enrollee – Continuity of Care Form?

1. New enrollees in a health insurance plan who are transitioning from another plan.
2. Patients with ongoing medical conditions requiring continuity of care.
3. Individuals who want to maintain their current healthcare providers during a plan change.

For pdfFiller’s FAQs

What is New Enrollee – Continuity of Care Form?

The New Enrollee – Continuity of Care Form is a document used by new members of a health insurance plan to request the continuation of care from their current healthcare providers during the transition to a new plan.

Who is required to file New Enrollee – Continuity of Care Form?

Individuals who are enrolling in a new health insurance plan and wish to maintain care with their existing providers are required to file the New Enrollee – Continuity of Care Form.

How to fill out New Enrollee – Continuity of Care Form?

To fill out the New Enrollee – Continuity of Care Form, you need to provide personal information, details of your current provider(s), the type of care being received, and reasons for requesting the continuation of care.

What is the purpose of New Enrollee – Continuity of Care Form?

The purpose of the New Enrollee – Continuity of Care Form is to ensure that new enrollees can continue receiving necessary medical care from their existing providers as they transition to a new health insurance plan.

What information must be reported on New Enrollee – Continuity of Care Form?

The information that must be reported includes the enrollee's personal details, current healthcare provider information, specifics about ongoing treatments, and any relevant medical history that supports the request for continuity of care.