The applicable address below: Manulife Financial, P.O. Box 1650, Waterloo, Ontario N2J 4P5 Manulife Financial, Group Health and Dental Claims, 2000 Mansfield St., Suite 1200, Montreal, Quebec H3A 3N8 1 General information Plan sponsor name Group number(s) Plan member ID Last name of plan member First name Middle initial Address of plan member City Last name of dependent First name Address of dependent 2 Disabled dependent information If you are completing this section of th.
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How to fill out the Gl4408e F online
Filling out the Gl4408e F form online is a straightforward process that requires attention to detail in order to meet all necessary requirements. This guide provides step-by-step instructions to ensure you complete the form accurately and efficiently.
Follow the steps to complete the Gl4408e F form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the group number(s), plan member ID, and the name of the plan sponsor. This information is crucial for identifying your coverage.
- Fill in the personal details of the plan member, including their last name, first name, middle initial, and address. Ensure the information is precise.
- Provide information about the dependent being covered. This includes the dependent's last name, first name, and their address.
- If applicable, complete the disabled dependent information section. Attach a report or letter from the dependent's personal physician confirming their diagnosis and prognosis.
- Specify the dependent’s relationship to the plan member and indicate their sex. Fill in additional fields regarding employment status and eligibility for other benefits.
- For over-age dependents who are students, provide details regarding their full-time status at an accredited institution, including school name, start and end dates of enrollment.
- If terminating coverage, indicate the dependent’s date of birth and the reason for termination, along with the effective date of termination.
- The plan member must sign and date the form to certify the truth and completeness of the information provided.
- Once all sections are complete, save changes, download your completed form, and prepare for submission as per the provided addresses.
Start completing your Gl4408e F form online today to ensure your over-age dependent needs are addressed.
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