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APPLICATION FOR EXTENDED HEALTH CARE, DENTAL, AND PRESTIGE TRAVEL/TRIP CANCELLATION PLANS If you have any questions about the Plan, or need assistance completing your application form, please contact

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How to fill out application for extended health

01

Start by gathering all the necessary information and documents required to fill out the application for extended health.

02

Carefully read and understand the instructions provided with the application form.

03

Fill out your personal details, including your name, address, contact information, and any other required personal information.

04

Provide information about your current health insurance coverage, if any.

05

Answer the questions related to your medical history, pre-existing conditions, and any medications or treatments you are currently undergoing.

06

Attach any supporting documents, such as medical reports or prescriptions, as required by the application.

07

Review the completed application form to ensure all information is correct and accurate.

08

Sign and date the application form.

09

Submit the filled-out application along with any required documents through the designated channels, such as by mail or online submission.

10

Keep a copy of the filled-out application and any supporting documents for your records.

Who needs application for extended health?

01

Anyone who requires extended health coverage and meets the eligibility criteria can apply for an extended health application.

02

This may include individuals who do not have existing health insurance coverage, those looking to enhance their current coverage, or individuals who have experienced changes in their health conditions or medical needs.

03

It is advisable to check the specific eligibility requirements and criteria set by the organization or provider offering the extended health coverage.

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What is application for extended health?

Application for extended health is a form that individuals fill out to apply for additional health coverage beyond what is provided by their basic health insurance.

Who is required to file application for extended health?

Anyone who wishes to have extended health coverage beyond their basic health insurance is required to file an application for extended health.

How to fill out application for extended health?

To fill out an application for extended health, individuals must provide their personal information, medical history, and any other relevant details requested on the form.

What is the purpose of application for extended health?

The purpose of an application for extended health is to apply for additional health coverage to supplement existing basic health insurance.

What information must be reported on application for extended health?

Information such as personal details, medical history, current health conditions, and any other relevant information must be reported on an application for extended health.

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