Get the free HEALTH PLAN CHANGE REPORT FORM

INSTRUCTIONS DHS 1179 (Rev. 10/13)HEALTH PLAN CHANGE REPORT FORM PURPOSE: The DHS 1179, Health Plan Change Report Form will be completed by the participating QUEST/DEXA Health Plans to report changes

How to fill out health plan change report

How to fill out health plan change report

1. Start by gathering all the necessary information and documents, such as your current health plan details and any changes you want to make.
2. Contact your health insurance provider or visit their website to obtain the health plan change report form.
3. Carefully read the instructions provided with the form to understand the requirements and guidelines for filling it out.
4. Begin filling out the form by entering your personal details, including your name, address, contact information, and policy number.
5. Clearly indicate the changes you want to make to your health plan, such as adding or removing dependents, changing coverage type, or modifying existing coverage details.
6. Provide any additional supporting documents or explanations required to support your requested changes.
7. Review the completed form to ensure all the necessary fields are filled out accurately and completely.
8. Sign and date the form to confirm the accuracy of the information provided and your consent for the requested changes.
9. Submit the filled-out health plan change report form to your health insurance provider through the designated channel, such as mailing it or submitting it online.
10. Keep a copy of the filled-out form for your records and follow up with your health insurance provider to confirm the receipt and processing of your request.

Who needs health plan change report?

1. Anyone who has an existing health plan and wishes to make changes to it needs to fill out a health plan change report. This can include individuals who want to add or remove dependents from their coverage, modify their coverage details, or switch to a different health plan offered by the same provider.

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What is health plan change report?

The health plan change report is a form used to report any changes in an individual's health insurance plan.

Who is required to file health plan change report?

Individuals who have made changes to their health insurance plan are required to file the health plan change report.

How to fill out health plan change report?

The health plan change report can usually be filled out online or through a paper form provided by the insurance company.

What is the purpose of health plan change report?

The purpose of the health plan change report is to ensure that the insurance company has up-to-date information on the individual's coverage.

What information must be reported on health plan change report?

The health plan change report typically requires information such as the individual's name, policy number, and details of the changes made to the plan.