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PRIOR COVERAGE
INFORMATION REQUEST
Complete this form if you or your dependents are applying for coverage or have recently (within the last 12 months) come onto coverage
through Regency Bluesier and
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How to fill out prior coverage information request
How to fill out prior coverage information request
01
Start by obtaining the prior coverage information request form from the respective organization or insurance company.
02
Carefully read the instructions and requirements mentioned on the form.
03
Fill in your personal details such as your name, contact information, and policy number (if applicable).
04
Provide accurate details about your prior coverage, including the start and end dates of the coverage.
05
Attach any supporting documents, such as a copy of your previous insurance policy or proof of coverage.
06
Review the completed form for any errors or missing information.
07
Submit the filled-out form and supporting documents either by mail, email, or through the designated online portal.
08
Follow up with the organization or insurance company to ensure that your request has been received and processed.
09
Keep a copy of the filled-out form and any related documents for your records.
Who needs prior coverage information request?
01
Prior coverage information request is usually needed by individuals who are applying for new insurance policies and have previously held insurance coverage.
02
It is also required by those who are transitioning to a different insurance provider and need to provide their previous coverage history.
03
Additionally, individuals who experienced a gap in their insurance coverage or had a policy canceled may be required to submit a prior coverage information request.
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What is prior coverage information request?
Prior coverage information request is a form used to collect information about an individual's previous insurance coverage.
Who is required to file prior coverage information request?
Individuals who are applying for new insurance coverage or changing their existing coverage may be required to file a prior coverage information request.
How to fill out prior coverage information request?
Prior coverage information request can usually be filled out online through the insurance provider's website or by requesting a paper form from the insurance company.
What is the purpose of prior coverage information request?
The purpose of prior coverage information request is to gather information about an individual's previous insurance coverage history in order to assess risk and determine pricing for new insurance coverage.
What information must be reported on prior coverage information request?
Information such as the name of previous insurance companies, policy numbers, coverage dates, and any claims history may need to be reported on a prior coverage information request form.
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