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Member Name Planholder SSN Date Member Relationship to Planholder Request for Accounting of Disclosures of I. Other uses and disclosures permitted or required by HIPAA are outlined in KEHP s Notice of Privacy Practices. Your Protected Health Information The Kentucky Employees Health Plan KEHP collects and maintains protected health information PHI that includes personal identifiers enrollment eligibility and dependent and qualifying event information. KEHP utilizes a third-party claims...

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01

Start by opening the membership form.

02

Locate the section labeled 'Member Name'.

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Individuals applying for membership

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Membership committees responsible for maintaining member records

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What is member name?

Member name is the legal name of an individual or entity who is a member of a particular organization or group.

Who is required to file member name?

The person or entity responsible for filing member name is typically the administrative head of the organization or group.

How to fill out member name?

To fill out member name, you need to provide the full legal name of each member as it appears on official documents.

What is the purpose of member name?

The purpose of member name is to accurately identify and record the individuals or entities who are part of a particular organization or group.

What information must be reported on member name?

The information that must be reported on member name includes the full legal name of each member and any other identifying information required by the organization or group.

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