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Writers Guild-Industry Health Fund Jim Hedges, Chief Executive Officer EXTENDED COVERAGE PROGRAM Election Form Please complete this form and return it to the Health Fund office by the last day of

How to fill out extended coverage election form

How to fill out extended coverage election form:

1. Start by carefully reading the instructions provided with the form. This will help you understand the purpose of the form and the information you need to provide.
2. Fill in your personal information accurately, including your full name, address, and contact details. Make sure to double-check for any spelling errors or inaccuracies.
3. Identify the insurer or plan for which you are making the extended coverage election. Provide the necessary details about the insurance plan, including its name and policy number.
4. Indicate the coverage period for which you are making the election. This could be a specific time frame or an open-ended election, depending on the options provided by the insurer or plan.
5. Consider any additional factors or circumstances that may affect your decision to elect extended coverage. For example, if you have pre-existing conditions that require ongoing treatment, ensure that you understand the implications of your election.
6. Review your completed form for accuracy and completeness before submitting it. It's crucial to ensure that all required fields are filled out properly and that there are no missing or incorrect details.

Who needs extended coverage election form:

1. Employees who have the option to choose extended coverage through their employer's insurance plans may need to fill out the extended coverage election form.
2. Individuals who are eligible for extended coverage through a government program or a private insurance plan may be required to complete this form to elect or decline the extended coverage.
3. Dependents or family members who are covered under an existing insurance plan and have the option to extend their coverage may also need to fill out this form to make their election.

Note: The specific requirements for filling out the extended coverage election form may vary based on the insurer, employer, or program offering the extended coverage. It is always advisable to carefully review the instructions provided with the form and seek assistance or clarification if needed.

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What is extended coverage election form?

Extended coverage election form is a form that allows individuals to elect to continue their health insurance coverage beyond the standard coverage period.

Who is required to file extended coverage election form?

Individuals who wish to extend their health insurance coverage beyond the standard period are required to file the extended coverage election form.

How to fill out extended coverage election form?

Extended coverage election form can be filled out by providing personal information, selecting the extended coverage period, and submitting any required documentation.

What is the purpose of extended coverage election form?

The purpose of extended coverage election form is to enable individuals to maintain their health insurance coverage for a longer period of time.

What information must be reported on extended coverage election form?

Extended coverage election form requires personal information, extended coverage period selection, and any necessary supporting documentation.