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MICHIGAN BAC HEALTH CARE FUND Managed for the Trustees by: TIC INTERNATIONAL CORPORATIONREQUEST FOR EXTENSION OF COVERAGE FOR AN ADULT CHILD UNDER AGE 26 (Please Type or Print Clearly)Participants

How to fill out dependent 26 form revised

How to fill out dependent 26 form revised

1. To fill out the dependent 26 form revised, follow these steps:
2. Start by downloading the dependent 26 form revised from the official website or obtain a physical copy from the concerned authorities.
3. Read all the instructions provided on the form carefully to ensure proper understanding.
4. Begin filling out the form by providing your personal details, such as your full name, address, phone number, and Social Security Number (SSN).
5. If you are filling out the form for a dependent, provide their full name, relationship to you, and their SSN.
6. Fill in the necessary information regarding the dependent's insurance coverage, including the policy number, the name of the insurance company, and the type of coverage.
7. Provide any additional information as required, such as other insurance coverage or any circumstances that may affect the dependent's eligibility.
8. Double-check all the entered information for accuracy and make any necessary corrections.
9. Sign and date the form where indicated.
10. Attach any supporting documents, if required, such as proof of dependency or insurance coverage.
11. Submit the completed form along with any supporting documents to the appropriate authority or organization as instructed.
12. Retain a copy of the completed form and supporting documents for your records.

Who needs dependent 26 form revised?

1. The dependent 26 form revised is needed by individuals who have dependents that may be eligible for extended healthcare coverage under certain circumstances.
2. This form is typically required by individuals who have dependents who have reached the age of 26 and wish to continue their health insurance coverage beyond that age.
3. It is also required when certain events or changes in circumstances make a dependent eligible for extended coverage, such as loss of other insurance coverage or becoming a full-time student.
4. If you have a dependent who meets these criteria, you may need to fill out the dependent 26 form revised.

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