Get Additional Dependent Form - Brokernet Kp

Filling out the Additional Dependent Form - Brokernet Kp online can streamline the process of adding dependents to your health plan. This guide provides clear and concise instructions to help you accurately complete each section of the form.

Follow the steps to accurately complete the Additional Dependent Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing the employer section, which includes the company name, effective date of coverage, group number, and medical and dental subgroup numbers, if applicable.
3. In section A, enter your name, gender, any former or maiden name, date of birth, and Social Security number in the provided fields.
4. For section B, enter the dependent information. Input each dependent's name, gender, status as a full-time student, date of birth, Social Security number, and whether they are eligible for Medicare.
5. For each dependent, indicate if they have other health insurance coverage and provide health record numbers as necessary.
6. Complete any additional dependent entries as needed, ensuring all required fields are filled out correctly.
7. In section C, acknowledge the importance of providing accurate information and sign and date the form to confirm your submission.
8. Once completed, save your changes. You can then download, print, or share the form as needed.

Complete your forms online today to ensure all dependents are documented accurately.