Get Intermediate - Customer Service

Filling out the Intermediate - Customer Service form is a crucial step in managing your contraceptive benefits under your health plan. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to accurately fill out the Intermediate - Customer Service form.

1. Click ‘Get Form’ button to acquire the form and access it in your editor.
2. In the section labeled 'Printed Name of Subscriber,' enter your full name as it appears on your health benefit plan. This ensures that your request is properly linked to your account.
3. For 'Date of Birth of Subscriber,' fill in your date of birth to verify your identity and eligibility.
4. Input your 'Subscriber Identification Number' in the designated field. This number is essential for identifying your specific policy.
5. Complete the 'Group Name' and 'Group Number' fields with the relevant details corresponding to your employer's health benefit plan.
6. Sign the form in the section marked 'Signature of Subscriber' to validate your request. Make sure to date the signature to reflect when you are submitting this request.
7. After ensuring all the fields are accurately filled, save your changes. You can opt to download a copy, print it, or share it as necessary.

Take the first step towards modifying your health benefit coverage by filling out the Intermediate - Customer Service form online today.