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California Public Employees Retirement System P.O. Box 942715 Sacramento, CA 942292715 HEALTH BENEFIT PLAN ENROLLMENT FORM DO NOT SEND MEDICAL PERSHBD12 (Rev. 6/17) CLAIMS TO THIS ADDRESS PLEASE TYPE

How to fill out change of coverage

How to fill out change of coverage

1. Start by obtaining the change of coverage form from your insurance provider.
2. Read through the form carefully, ensuring that you understand all the sections and requirements.
3. Provide your personal information such as your name, address, contact details, and policy number.
4. Indicate the type of coverage change you are requesting, whether it is an increase or decrease in coverage, adding or removing a beneficiary, or other changes.
5. Provide any necessary supporting documentation, such as medical records or proof of life changes, depending on the nature of the coverage change.
6. Double-check all the information you have provided to avoid any mistakes or inaccuracies.
7. Sign and date the form, certifying that the information provided is true and accurate.
8. Submit the completed change of coverage form to your insurance provider through the preferred method, such as mail, email, or online submission.
9. Follow up with your insurance provider to ensure that your requested change of coverage has been processed and implemented.
10. Review your updated coverage documents and verify that the requested changes have been accurately reflected.

Who needs change of coverage?

1. Individuals who wish to modify their existing insurance coverage.
2. Policyholders who have experienced life changes, such as marriage, divorce, birth, or adoption, and need to update their coverage accordingly.
3. Those who want to adjust their coverage limits or make changes to beneficiaries.
4. Organizations or businesses that need to modify their group insurance coverage for employees.
5. Anyone whose insurance needs have changed and requires a different level or type of coverage.

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What is change of coverage?

Change of coverage refers to the process of updating or modifying an individual's insurance policy to reflect any changes in coverage, such as adding or removing dependents, changing coverage levels, or switching insurance carriers.

Who is required to file change of coverage?

Individuals who experience qualifying life events, such as getting married, having a baby, or losing other health coverage, are typically required to file a change of coverage to update their insurance policy.

How to fill out change of coverage?

To fill out a change of coverage form, individuals typically need to provide information such as their personal details, the type of coverage changes they are requesting, and any documentation supporting the change (e.g. marriage certificate, birth certificate). The form can usually be submitted online, by mail, or through the insurance provider's customer service portal.

What is the purpose of change of coverage?

The purpose of change of coverage is to ensure that an individual's insurance policy accurately reflects their current coverage needs and circumstances. This helps to avoid any gaps in coverage or unnecessary expenses.

What information must be reported on change of coverage?

Information that must be reported on a change of coverage form typically includes the policyholder's name, address, contact information, any changes to dependent information, and details about the requested coverage changes.