Get the free SEBB Medical Change Form (20-0372)

2024 School Employee Enrollment /Change Form Medical only groups Please use this form if you are unable to use Benefits 24/7 (available in January 2024) at benefits247.hca.wa.gov. The information

How to fill out sebb medical change form

How to fill out sebb medical change form

1. To fill out the SEBB Medical Change Form, follow these steps:
2. Start by providing your personal information, including your name, address, and contact information.
3. Indicate the effective date of the medical change you are making.
4. Choose the type of medical change you are making, such as enrolling in a new plan, canceling an existing plan, or updating your dependent information.
5. If you are enrolling in a new plan, provide the details of the plan you wish to enroll in.
6. If you are canceling an existing plan, indicate the plan you want to cancel and the reason for cancellation.
7. If you are updating dependent information, provide the necessary details of the dependents you want to add or remove.
8. Review the form to ensure all information is accurate and complete.
9. Sign and date the form.
10. Submit the form to the appropriate authority as per your SEBB program guidelines.

Who needs sebb medical change form?

1. The SEBB Medical Change Form is needed by individuals who are enrolled in the SEBB Program and want to make changes to their medical coverage.
2. This form is required if you are enrolling in a new medical plan, canceling an existing plan, or updating your dependent information.

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What is sebb medical change form?

The SEBB medical change form is a document used by employees and dependents of the School Employees Benefits Board (SEBB) to report changes in their medical insurance coverage.

Who is required to file sebb medical change form?

Employees and dependents who experience qualifying life events such as marriage, divorce, the birth of a child, or loss of other coverage are required to file the SEBB medical change form.

How to fill out sebb medical change form?

To fill out the SEBB medical change form, individuals must provide accurate personal information, specify the type of change, and provide any required supporting documentation.

What is the purpose of sebb medical change form?

The purpose of the SEBB medical change form is to facilitate reporting changes in eligibility and coverage, ensuring that employees and their dependents receive appropriate health benefits.

What information must be reported on sebb medical change form?

The form must include personal identification information, details of the qualifying event, and any other relevant information required by SEBB to process the change.