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Transition Coverage Request Personal & Confidential This form does not apply to fully insured commercial members in California (See other side for TransitionofCare coverage questions and answers)

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What is transition coverage request?

A transition coverage request is a formal request made to the appropriate authority to provide insurance coverage during a transition period.

Who is required to file transition coverage request?

Any individual or organization seeking insurance coverage during a transition period is required to file a transition coverage request.

How to fill out transition coverage request?

To fill out a transition coverage request, you need to download the request form from the official website of the authority, fill in the required information accurately, and submit it according to the provided instructions.

What is the purpose of transition coverage request?

The purpose of a transition coverage request is to ensure continuous insurance coverage during a period of transition, such as changing insurance providers or policies.

What information must be reported on transition coverage request?

The transition coverage request typically requires information such as the applicant's name, contact details, current insurance policy details, transition period dates, and any additional relevant information specified by the authority.

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