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Percale Enrollment/Change Form Combination Premedical and Medicare Coverage2023 Colorado Public Employees Retirement Association PO Box 5800, Denver, Colorado 802175800 1800759PERA (7372) Fax: 3038633727
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How to fill out peracare enrollmentchange form pre-medicare
How to fill out peracare enrollmentchange form pre-medicare
01
Obtain the Peracare enrollment change form pre-medicare from the Peracare website or your healthcare provider.
02
Fill out your personal information including your name, address, date of birth, and social security number.
03
Indicate the changes you wish to make to your coverage, such as adding or removing dependents or changing your plan option.
04
Provide any supporting documentation required for the changes you are making.
05
Sign and date the form to certify that the information you provided is accurate.
06
Submit the completed form to Peracare according to the instructions provided.
Who needs peracare enrollmentchange form pre-medicare?
01
Individuals who are currently enrolled in Peracare and are approaching Medicare eligibility age.
02
Individuals who wish to make changes to their Peracare coverage before transitioning to Medicare.
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What is peracare enrollmentchange form pre-medicare?
Peracare enrollmentchange form pre-medicare is a form used to make changes to your healthcare coverage before becoming eligible for Medicare.
Who is required to file peracare enrollmentchange form pre-medicare?
Individuals who are enrolled in Peracare and are approaching Medicare eligibility are required to file the enrollmentchange form.
How to fill out peracare enrollmentchange form pre-medicare?
To fill out the peracare enrollmentchange form pre-medicare, you must provide information about your current coverage, the changes you want to make, and your upcoming Medicare eligibility.
What is the purpose of peracare enrollmentchange form pre-medicare?
The purpose of the peracare enrollmentchange form pre-medicare is to allow individuals to adjust their healthcare coverage before transitioning to Medicare.
What information must be reported on peracare enrollmentchange form pre-medicare?
The form requires information such as personal details, current coverage details, desired changes, and upcoming Medicare eligibility date.
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