Get Section I To Be Completed By The Subscriber

Filling out the SECTION I TO BE COMPLETED BY THE SUBSCRIBER form is an essential step in the evaluation process for a dependent's coverage. This guide will provide you with clear instructions on how to accurately complete each field of the form online.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your online editor.
2. Begin by entering the subscriber's name and ID number in the designated fields. Ensure that you provide accurate and up-to-date information.
3. Fill in the home address of the subscriber carefully, including street address, city, state, and zip code.
4. Provide the dependent’s name and date of birth. Make sure to use the correct format for the date.
5. Indicate the relationship between the subscriber and the dependent in the appropriate field.
6. If the dependent resides at a different address, fill in their address in the respective section.
7. List the name(s) of the medical condition affecting the dependent. Be as specific as possible.
8. Record the month and year of the first treatment for the condition. Provide a similar entry for the most recent treatment.
9. Answer whether the dependent attends school by selecting 'YES' or 'NO'. If they are part-time or full-time, indicate the hours per week.
10. Indicate whether the dependent is able to work, and if so, please specify where and how many hours they work each week.
11. Complete the sections on whether the dependent has applied for supplemental security income or social security disability insurance, and about their eligibility status.
12. Answer questions regarding the dependent’s age, residence, previous health insurance coverage, and provide any additional required documents such as certificates or letters.
13. Review all entered information and ensure accuracy. Once confirmed, proceed to submit the form.
14. Finally, save your changes. You may also choose to download, print, or share the form as needed.

Complete your form online today for efficient processing.