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                Get Ca Hbex 403 2017-2025
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How to fill out the CA HBEX 403 online
The CA HBEX 403 form, known as the Authorization for Release of Personal Information & Appointment of Representative, allows users to authorize Covered California to share their personal information. This guide provides a step-by-step approach to completing this form online.
Follow the steps to complete the CA HBEX 403 form online.
- Click ‘Get Form’ button to access the CA HBEX 403 form and have it open in your editor for online completion.
- Fill in the consumer information section, which includes your first name, last name, middle initial, address, city/state, zip code, Covered California account number, date of birth, daytime phone number, and email address.
- For consumer address verification, attach a copy of a valid document such as a California Driver’s License or a utility bill with your name and current address.
- For consumer identity verification, attach a copy of a valid identification document, or ensure your signature is notarized if no identification is attached. Specify the date signed and the notary details if applicable.
- In the consumer authorization section, specify the name of the individual or entity you are authorizing, along with their address, background information, and the purpose for the release of your personal information.
- If you wish to appoint the individual as your authorized representative, check the designated box, then sign and date the form to complete this authorization.
- Repeat the verification process for the authorized representative, including identity and address verification documents. Ensure all requirements are met.
- After completing the form, you can save your changes, download the completed form, print it, or share it as needed.
Complete your CA HBEX 403 form online today to ensure your information is authorized for release.
To remove someone from Covered California, you must submit a request through their online portal or contact customer service directly. It's important to provide the necessary identification and documentation for that individual. By addressing changes promptly, in accordance with CA HBEX 403, you ensure that your coverage accurately reflects your household.
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