Get Kaiser Permanente 2016 Grandfather Member Account Change Formfillablelck

Filling out the Kaiser Permanente 2016 Grandfather Member Account Change FormFillableLck is essential for managing your health plan changes. This guide provides clear, step-by-step instructions to help you complete the form accurately online.

Follow the steps to successfully complete your account change form.

1. Click the ‘Get Form’ button to access the form and open it for editing.
2. In Section A, you will enter your personal information. Include your first name, middle initial, last name, medical record number, home address, city, state, ZIP code, billing address (check if it’s the same as your home address), phone number, requested effective date, and your Social Security number.
3. Move to Section B, where you will select the changes you want to make. Check the circles next to the changes applicable to you, and ensure to list each family member affected by these changes.
4. In Section C, provide details about each family member affected by the changes. Fill in their first name, middle name, last name, Social Security number, medical record number (if applicable), date of birth, and the specific changes (e.g., add or end medical coverage).
5. Finally, review the chosen health plan options in Section D. Select your desired health plan by checking the appropriate circle. If you are opting for additional dental coverage, ensure to indicate your choice in the corresponding section.
6. In the Plan Change Agreement section, read the terms carefully, and sign and date where required. This confirmation is essential for your application process.
7. Make sure to review the entire form for accuracy. Once completed, you can save your changes, download, print, or share the form to submit it.

Access and complete your Kaiser Permanente 2016 Grandfather Member Account Change FormFillableLck online today for swift processing.