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Application for Spouse/Secondary Member Card Please complete the below to provide the requested named individual a spouse/secondary member card. I certify the individual named below is eligible for

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What is pca spouse-secondary member application?

The PCA spouse-secondary member application is an application form used to register a spouse as a secondary member under a Primary Care Agreement (PCA), enabling them to access certain benefits and services associated with the primary member's coverage.

Who is required to file pca spouse-secondary member application?

The primary member of a PCA who wishes to enroll their spouse as a secondary member is required to file the PCA spouse-secondary member application.

How to fill out pca spouse-secondary member application?

To fill out the PCA spouse-secondary member application, the primary member must provide personal details of both themselves and their spouse, including names, contact information, and any necessary identification numbers. It's important to follow the instructions on the form carefully to ensure all required fields are completed.

What is the purpose of pca spouse-secondary member application?

The purpose of the PCA spouse-secondary member application is to officially include a spouse in the primary member's PCA coverage, allowing them to access health care services and benefits that come with the coverage.

What information must be reported on pca spouse-secondary member application?

The information that must be reported on the PCA spouse-secondary member application includes the primary member's personal information, spouse's personal information, relationship status, and any relevant health or identification details as required by the application form.

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