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Fax (614) 3409444 Phone (800) 2821526 Email: insurance@oda.org 1370 Dublin Road Columbus, OH 432151098 www.odawt.orgElection Change Form Add Dependent(s) Employer Name: Group #: Subscriber Name:LastFirstMIAddress:
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Gather all necessary personal information such as name, address, social security number, and date of birth.
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Research the different health benefits options available to you through your employer or government programs.
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Fill out the health benefits form accurately and completely, double-checking all information before submitting.
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Submit the form according to the instructions provided by your employer or the program administrator.

Who needs health benefits for you?

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Anyone who requires medical care and wants financial assistance to cover the cost.
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Health benefits refer to the services or products that help support your physical and mental well-being.
The individual who is receiving the health benefits is typically required to file for them.
You can fill out health benefits forms by providing accurate information about your health and any services or products you are receiving.
The purpose of health benefits is to ensure that individuals have access to the necessary medical services and products they need to maintain their health.
Information such as medical history, services received, medications taken, and any health conditions must be reported on health benefits forms.
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