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EVIDENCE OF INSURABILITY FORM
Page 1 of 6And its Affiliates and Subsidiaries
PO Box 14319
Lexington, KY 40512Please complete this form in ink. As a convenient alternative, for Life and Disability
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What is group plan no?
Group plan no is a unique identification number assigned to a group plan.
Who is required to file group plan no?
Employers who offer group health insurance plans are required to file group plan no.
How to fill out group plan no?
Group plan no can be filled out by providing the necessary information about the group health insurance plan.
What is the purpose of group plan no?
The purpose of group plan no is to identify and track group health insurance plans.
What information must be reported on group plan no?
Group plan no must include information such as plan coverage, plan administrator, and plan benefits.
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