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CONTINUATION OF MEDICAL BENEFITSSubject to the terms stated in your certificate, Continuation of Medical benefits may be available for you and/or your covered dependents. Please refer to the certificate
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How to fill out continuation of medicaldental benefits

01
To fill out the continuation of medical dental benefits form, follow these steps:
02
Obtain the form from your employer or insurance provider.
03
Fill in your personal information, including your name, address, and contact details.
04
Provide your employment information, such as your job title and employer's name.
05
Indicate the reason for needing continuation of medical dental benefits.
06
Specify the start and end dates for the continuation period.
07
Fill in details about your current medical or dental coverage, including insurance provider and policy number.
08
Attach any supporting documentation required, such as medical records or proof of eligibility.
09
Review the form to ensure all information is accurate and complete.
10
Sign and date the form.
11
Submit the completed form to your employer or insurance provider as instructed.

Who needs continuation of medicaldental benefits?

01
Anyone who is facing the termination of their current medical dental benefits and wishes to continue receiving coverage may require the continuation of medical dental benefits. This may include individuals who are leaving their current job, experiencing a change in employment status, or going through a divorce or separation.

What is CONTINUATION OF MEDICAL/DENTAL BENEFITS Form?

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Continuation of medical/dental benefits refers to the option for individuals to maintain their health insurance coverage after a qualifying event, such as employment termination or reduction in hours.
Employers with group health plans are required to offer continuation of benefits to employees and their dependents who lose coverage due to qualifying events under laws like COBRA.
To fill out the continuation of medical/dental benefits, individuals typically need to complete a specific form provided by their employer or plan administrator, indicating their desire to continue coverage and providing necessary personal information.
The purpose of continuation of medical/dental benefits is to ensure that individuals and their dependents can maintain access to necessary medical care and coverage despite changes in employment status.
The information that must be reported includes the insured's personal details, the reason for loss of coverage, the dates of coverage, and any other specific information required by the insurer.
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