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Access+ HMO Basic Plan CC POA Medical PlanEvidence of Coverage and Disclosure Form Effective January 1, 2019Sponsored by California Correctional Peace Officers Association Benefit Trust Fund Approved
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How to fill out ccpoa access hmo basic
How to fill out ccpoa access hmo basic
01
To fill out CCPA Access HMO Basic, follow these steps:
02
Start by entering your personal information, including your full name, address, and contact details.
03
Provide your employment information, such as your job title, employer name, and work address.
04
Next, fill in the details of your dependents, if applicable. Include their names, dates of birth, and relationship to you.
05
Indicate your preferred primary care physician (PCP) by providing their name and contact information.
06
Review the list of covered services and select any additional benefits you would like to include.
07
Sign and date the form to confirm your understanding and agreement to the terms and conditions.
08
Finally, submit the completed form to the appropriate authority or insurance provider.
Who needs ccpoa access hmo basic?
01
CCPOA Access HMO Basic is typically needed by individuals who are members of the California Correctional Peace Officers Association (CCPOA) and their eligible dependents.
02
This particular plan is designed to provide comprehensive healthcare coverage for correctional officers and their families, ensuring access to a network of healthcare providers, including primary care physicians, specialists, hospitals, and pharmacies.
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What is ccpoa access hmo basic?
ccpoa access hmo basic refers to a type of health maintenance organization plan available to members of the California Correctional Peace Officers Association (CCPOA).
Who is required to file ccpoa access hmo basic?
Members of the CCPOA who wish to enroll in the access HMO basic plan are required to file for it.
How to fill out ccpoa access hmo basic?
To fill out the ccpoa access HMO basic plan, members need to follow the enrollment instructions provided by the CCPOA.
What is the purpose of ccpoa access hmo basic?
The purpose of ccpoa access hmo basic is to provide affordable health care coverage to members of the CCPOA and their families.
What information must be reported on ccpoa access hmo basic?
Members must report personal information, dependent information, and any other relevant details required by the CCPOA for enrollment in the access HMO basic plan.
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