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PLUMBERS LOCAL UNION No. 1 WELFARE FUND 5002 Fifth Street, Long Island City, N.Y. 11101 www.ualocal1funds.orgSPECIAL ENROLLMENT FORM Tel. (718) 835270010/2017Use a ballpoint pen to complete form(A)
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Open the specialenrollmentformdoc in a document editor.
02
Start by filling out the personal information section, including your full name, date of birth, and contact details.
03
Move on to the eligibility section and provide information about your current insurance coverage and reasons for needing a special enrollment period.
04
Complete the attestation section, where you certify the accuracy of the information provided.
05
Review the form for any errors or missing information.
06
Sign and date the form.
07
Submit the form as instructed, either by mail or electronically.
Who needs specialenrollmentformdoc?
01
Specialenrollmentformdoc is needed by individuals who experience a qualifying life event that makes them eligible for a special enrollment period. This may include situations such as losing health coverage, getting married, having a baby, or moving to a new location.
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What is specialenrollmentformdoc?
Specialenrollmentformdoc is a form used to request special enrollment in a health insurance plan outside of the regular enrollment period.
Who is required to file specialenrollmentformdoc?
Individuals who experience a qualifying life event such as marriage, birth of a child, loss of other coverage, or a move to a new coverage area are required to file specialenrollmentformdoc.
How to fill out specialenrollmentformdoc?
Specialenrollmentformdoc can typically be filled out online through the healthcare marketplace website or by contacting the insurance provider directly.
What is the purpose of specialenrollmentformdoc?
The purpose of specialenrollmentformdoc is to allow individuals to enroll in a health insurance plan outside of the regular enrollment period due to qualifying life events.
What information must be reported on specialenrollmentformdoc?
Specialenrollmentformdoc requires information such as the qualifying life event, date of the event, and any supporting documentation.
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