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  • Po Box 1987 Grapevine Tx 76099

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ALLIED PILOTS ASSOCIATION ENROLLMENT/CHANGE FORM Return completed form to WEB-TPA P. O. Box 1987 Grapevine TX 76099-1987 1-800-477-8957 Fax 469-417-1979 VOLUNTARY SUPPLEMENTAL MEDICAL CUSTODIAL CARE BENEFIT PLAN SMP Check appropriate box. I Enrollment/Re-enrollment Name Last First Middle Initial I Dependent Change Street Address Employee Number City Date of Birth MO/DAY/ YR / Date of Hire State Zip Code Date of Recall First Name Gender I Married I Single I American Airlines I Staff List any periods of furlough paid or unpaid leave of absence sick personal family leave military leave etc* List dependents to be covered Last Name Telephone Number Status Check one I Active Flight Status I Retired I TAG I LOA I Surviving Spouse I Furlough I Military I SLOA I MDSB Date of Furlough Social Security Number Spouse Dependent Child If you are adding a spouse due to marriage or a dependent due to birth you must attach supporting documents i*e* marriage certificate birth certificate or coverage will....

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How to fill out the Po Box 1987 Grapevine Tx 76099 online

Completing the Po Box 1987 Grapevine Tx 76099 form is an important step for users wanting to enroll or make changes to their supplemental medical and custodial care benefits. This guide provides step-by-step instructions to ensure you fill out the form accurately and efficiently online.

Follow the steps to complete the form online seamlessly.

  1. Press the ‘Get Form’ button to retrieve the form and access it in the online editing tool.
  2. Begin by selecting the appropriate enrollment or change option by checking the box next to 'Enrollment/Re-enrollment' or 'Dependent Change'.
  3. Input your personal information in the designated fields, including your name, street address, employee number, and your city, state, and zip code.
  4. Fill in your date of birth and date of hire in the provided formats.
  5. Indicate your marital status by checking either 'Married' or 'Single'.
  6. List any periods of furlough or leave of absence that apply to you and the dependents you want covered.
  7. Provide your and your dependents' details such as their names, dates of birth, and social security numbers, ensuring to attach any necessary supporting documents if you're adding a spouse or dependent.
  8. Respond to the questions regarding your dependent children's health coverage by selecting 'Yes' or 'No'.
  9. Complete the Monthly ACH Deduction section by attaching the necessary ACH Transfer Form.
  10. Review your information for accuracy and completeness. Certify the correctness of the information by providing your signature.
  11. After confirming all details, save your changes, and choose to download, print, or share the completed form as needed.

Begin filling out your forms online today for a seamless experience.

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Payer ID 47198 typically refers to WebTPA, which handles various healthcare claims and related services. When sending claims, providers should use this payer ID to ensure smooth processing of payments. If you need more information regarding claims directed to Po Box 1987 Grapevine Tx 76099, consider exploring US Legal Forms for tailored solutions that meet your needs.

WebTPA serves a diverse range of clients, including employers, insurance agents, and health care providers. Businesses looking to optimize their insurance administration often turn to WebTPA for effective solutions tailored to their needs. With a strong commitment to service, they help organizations manage their health plans and benefits efficiently. If you’re located near Po Box 1987 Grapevine Tx 76099, local businesses can directly explore what WebTPA has to offer.

The payer ID for WebTPA is a unique identifier used in the claims process to facilitate transactions between health care providers and insurance companies. For specifics, it's best to refer directly to the resources or support provided by WebTPA. They can guide you to ensure you have the correct information to streamline your claims. You can easily contact them at Po Box 1987 Grapevine Tx 76099 for further assistance.

WebTPA specializes in various forms of insurance, including self-funded health plans, workers' compensation, and employee benefits. They work with businesses to provide comprehensive administration solutions, ensuring effective management of claims and member services. This flexibility allows organizations to customize their insurance plans according to their unique needs. For those interested, further information can be found by reaching out to Po Box 1987 Grapevine Tx 76099.

TPA stands for Third Party Administrator, which is a company like WebTPA that manages health insurance plans on behalf of other organizations. These administrators handle claims processing, member services, and compliance issues, freeing up businesses to focus on their core activities. TPA health insurance provides a streamlined approach, offering support to both employers and employees. If you need assistance, visiting or contacting Po Box 1987 Grapevine Tx 76099 can connect you directly to the services offered by WebTPA.

WebTPA headquarters is located in Grapevine, Texas, which provides a central point for their operations. This strategic location helps them serve clients efficiently across the country. You can also contact them via mail at Po Box 1987 Grapevine Tx 76099 for more information or assistance. Their dedicated team is always ready to help you with your needs.

WebTPA specializes in third-party administration services for insurance claims. They provide insurance solutions that help businesses manage their claims efficiently. By harnessing their expertise, companies can streamline operations and enhance customer satisfaction. Remember, you can also find them at Po Box 1987 Grapevine Tx 76099 for any specific inquiries regarding their services.

You can reach WebTPA by visiting their official website for contact details. Look for the contact section, where you will find various ways to connect with them, including email and phone support. If you prefer physical mail, you can send your inquiries to Po Box 1987 Grapevine Tx 76099. This ensures that your questions receive the attention they deserve from their dedicated team.

If you have further questions, please call 844.380. 4554, email helpme@webtpa.com or fill out the Ask A Question form on your WebTPA Provider Portal at .webtpa.com.

WebTPA is the claims administrator and they handle matters such as eligibility, processing and paying claims on the City's behalf, determining plan coverage, etc. WebTPA is the number on your insurance card that you will call for benefit questions.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232