Get Insurance Verification Form

Filling out the Insurance Verification Form is a crucial step in ensuring that your eligible spouse receives the appropriate health coverage. This guide provides a clear, step-by-step process to help you complete the form online with confidence and accuracy.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'Your Information' section, provide your last name, first name, middle initial, home address, social security number, city, local union, employer name, job title, birthdate, state, language preference, zip code, sex, telephone number, and email address.
3. Next, move to the 'Your Dependent Spouse Information' section. Here, enter the last name, first name, middle initial, employer name, social security number, birthdate, sex, and employer address of your spouse.
4. Indicate whether your spouse is eligible for their employer's health plan. If 'No,' check the appropriate reason. If 'Yes,' select the box that applies to your spouse's enrollment status.
5. If your spouse has employer health benefits, please fill in the name of the insurance company, policy number, and employer address. Then, check all applicable coverage types, including single coverage, family coverage, medical, and dental.
6. In the 'Consent Information' section, read the acknowledgment statement carefully. You will need to sign and date the form to certify that the information provided is accurate and complete.
7. Finally, ensure to save your changes, download the form, and print it if needed. You can then share or return the completed form to the Culinary Health Fund at the address provided.

Complete your Insurance Verification Form online today to ensure your spouse's health coverage is maintained.