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GRAND VALLEY STATE
UNIVERSITY
GROUP BENEFIT PLANSUMMARY PLAN DESCRIPTION
AND AMENDMENTS
Preferred Provider Organization (PPO)
High Deductible Health Plan (DHP) Plan
Effective January 1, 2014,
Updated
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How to fill out ancillary provider benefit change
How to fill out ancillary provider benefit change
01
To fill out an ancillary provider benefit change, follow these steps:
02
Obtain the ancillary provider benefit change form from your insurance provider.
03
Fill in your personal information, including your name, address, and contact details.
04
Provide information about your current ancillary provider and services.
05
Specify the changes you want to make to your ancillary provider benefits.
06
If necessary, attach any supporting documents or letters explaining your request.
07
Review the completed form for accuracy and completeness.
08
Sign and date the form.
09
Submit the filled-out form to your insurance provider as per their instructions.
10
Keep a copy of the completed form for your records.
11
Wait for confirmation from your insurance provider regarding the changes made to your ancillary provider benefits.
Who needs ancillary provider benefit change?
01
Anyone who currently has ancillary provider benefits and wishes to make changes to their coverage or provider may need to fill out an ancillary provider benefit change form.
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What is ancillary provider benefit change?
Ancillary provider benefit change refers to any updates or modifications made to the benefits provided by ancillary providers.
Who is required to file ancillary provider benefit change?
Any entity or organization that works with ancillary providers and makes changes to their benefit offerings is required to file an ancillary provider benefit change.
How to fill out ancillary provider benefit change?
You can fill out an ancillary provider benefit change form by providing all the required information about the changes made to the benefit offerings of ancillary providers.
What is the purpose of ancillary provider benefit change?
The purpose of ancillary provider benefit change is to ensure that all parties involved are aware of any updates or modifications made to the benefits provided by ancillary providers.
What information must be reported on ancillary provider benefit change?
Information such as the name of the ancillary provider, details of the changes made to the benefit offerings, effective date of the changes, and any other relevant details must be reported on an ancillary provider benefit change form.
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