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Get Request For Continuation Of Medical Coverage For Disabled Student Form 2009-2025
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How to fill out the Request For Continuation Of Medical Coverage For Disabled Student Form online
Filling out the Request For Continuation Of Medical Coverage For Disabled Student Form online is a straightforward process. This guide will provide clear, step-by-step instructions to help you navigate through the form efficiently and accurately.
Follow the steps to complete your form with ease.
- Click ‘Get Form’ button to access the form and open it in the editor.
- Begin by entering your employee information. This includes your name, social security number, and address. Make sure to fill in all required fields accurately.
- Next, provide your employer's information. Include the employer's name, policy number, and the effective date of coverage.
- In the prior plan information section, indicate whether your dependent was covered under a previous plan. If yes, provide the date the prior plan started and the name and telephone number of the prior carrier.
- Complete the employee statement by ensuring that your answers are complete and correct. You will need to sign and date this section.
- Fill out the physician information section with details of the attending physician, including their name, address, and telephone number.
- In the employee signature and release section, authorize health care providers to share information with Aetna regarding your dependent's care. Remember to sign and date this section.
- Provide information about the dependent, including their birth date, name, and social security number.
- For handicap child information, specify the start date of the incapacity and how it affects the dependent’s ability to support themselves. Complete any additional questions regarding education, work history, and living arrangements.
- If applicable, fill out the disabled student information section. Answer whether the dependent has stopped attending school due to a disability and provide the relevant dates and intentions regarding their return.
- After you have completed all required sections, review the entire form for accuracy. Save any changes, then choose to download, print, or share the completed form as needed.
Complete your Request For Continuation Of Medical Coverage For Disabled Student Form online today.
When applying for the Disabled Students Allowance, you will need to submit evidence that clearly illustrates your disability and its educational impact. This often includes a diagnostic assessment or a report from a healthcare professional. A well-prepared Request For Continuation Of Medical Coverage For Disabled Student Form will facilitate your process and ensure all necessary evidence is presented.
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