Get the free Statement of Health - University of Nebraska System
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EMPLOYEE GROUP
ENROLLMENT FORMASSURITY LIFE INSURANCE COMPANY
Post Office Box 82533, Lincoln, NE 685012533
(402) 4766500 (866) 2897337 www.assurity.com
New EnrolleeCoverage Change. Employee Information
First,
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How to fill out statement of health
How to fill out statement of health
01
Obtain a copy of the statement of health form from the appropriate source.
02
Fill out all required personal information such as name, date of birth, and contact information.
03
Provide detailed information about any medical conditions or treatments you have undergone.
04
Answer all health-related questions honestly and accurately.
05
Sign and date the statement of health form before submitting it to the relevant party.
Who needs statement of health?
01
Individuals applying for life insurance policies.
02
Individuals applying for certain types of loans.
03
Employees enrolling in employer-sponsored health insurance plans.
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What is statement of health?
The statement of health is a form that includes information about an individual's health status.
Who is required to file statement of health?
Individuals who are applying for certain types of insurance policies are required to file a statement of health.
How to fill out statement of health?
The statement of health form can be filled out by providing accurate and detailed information about one's health history and current health status.
What is the purpose of statement of health?
The purpose of the statement of health is to assess the health risks associated with insuring an individual.
What information must be reported on statement of health?
Information such as medical history, current medications, any pre-existing conditions, lifestyle habits, and family medical history must be reported on the statement of health.
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