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Empire Plan Certificate Amendments District Council 37For employees of the State of New York represented by District Council 37 (DC37), their enrolled dependents, COBRA enrolled and Young Adult Option
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01
Obtain a copy of the Empire Plan certificate amendments form.
02
Read and understand the instructions provided on the form.
03
Fill in your personal information such as your name, address, and contact details.
04
Review your current Empire Plan certificate to identify the amendments that you need to make.
05
Fill in the amendments section of the form, clearly stating the changes you want to make.
06
Provide any supporting documents or explanations, if required.
07
Double-check all the information you have provided to ensure accuracy and completeness.
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Sign and date the form.
09
Submit the completed form along with any required supporting documents to the appropriate authority or insurance provider.
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Keep a copy of the submitted form for your records.

Who needs empire plan certificate amendments?

01
Anyone who is a member of the Empire Plan and requires specific changes or updates to their certificate needs Empire Plan certificate amendments.
02
This could include individuals who have had a change in personal information (e.g., change of address), changes in coverage options, or changes in dependents (e.g., adding or removing family members from the plan).
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Empire Plan certificate amendments are changes or updates made to the details of an Empire Plan certificate.
Employers offering Empire Plan health insurance coverage are required to file Empire Plan certificate amendments.
Empire Plan certificate amendments can be filled out by completing the necessary form provided by the Empire Plan administrator.
The purpose of Empire Plan certificate amendments is to ensure accurate and updated information on the health insurance coverage being provided.
Empire Plan certificate amendments must report changes in coverage details, such as plan options, premiums, and covered individuals.
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