Get Covered Ca Coverage Termination Bformb - Sharp Health Plan

This guide provides clear and detailed instructions for filling out the Covered CA Coverage Termination Form specific to Sharp Health Plan. Follow the step-by-step process to ensure your cancellation request is completed correctly.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your subscriber information. Fill out the fields for your first name, middle initial (if applicable), and last name. Next, provide your date of birth and your Sharp Health Plan Subscriber ID.
3. In the 'Enrollment Change' section, select one or more options that apply to your cancellation. Indicate whether you wish to cancel the policy for all covered members or just select individuals.
4. For a full cancellation, specify the requested effective date of cancellation. Note that cancellation cannot be retroactive, and it will affect the subscriber and all dependents covered under the plan.
5. If you are canceling only for specific individuals, select 'Cancel Policy only for' and choose whether this applies to your spouse, domestic partner, or child(ren). Then, indicate the requested effective date and list the names of the members to be canceled.
6. Finally, provide your signature and the date to validate your cancellation request.
7. Save your changes. You can then download, print, or share the completed form as needed for your records or to submit via email, fax, or mail.

Ensure your cancellation is processed by filling out the form online today.