Get Caf001acc/hi - Charlescountymd

Filling out the CAF001ACC/HI form is a crucial step in submitting your claim for accident and supplemental hospital and medical indemnity. This guide will provide you with clear, step-by-step instructions to help you complete the form effectively and efficiently.

Follow the steps to ensure your form is filled out correctly.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by completing section 1, which requires information about the policyholder. This includes the policyholder's name, policy/certificate number, social security number, date of birth, sex, email address, and telephone number.
3. In section 2, provide the policyholder's address, including street, city, state, and zip code.
4. Section 3 asks for details about the claimant, the person who is sick or injured. Fill in their name, date of birth, relationship to the policyholder, and contact number.
5. For section 4, describe the circumstances of the accident or the nature of the illness. Be as detailed as possible, including dates and events leading to the claim.
6. In section 5, indicate whether the accident or illness is work-related and if a worker’s compensation claim has been filed. Additionally, provide the status of that claim.
7. Section 6 requires you to note if you have received treatment in the last year, including details about the doctor or hospital visited.
8. After completing sections 1 through 7, read and sign the authorization in section 8. This is necessary for processing your claim. Make sure to date the signature.
9. Finally, review the entire form for accuracy, save your changes, and choose to download, print, or share the completed form as needed.

Ensure your claims are processed smoothly by completing the CAF001ACC/HI form online today.