Get Sw15038-change Of Status Form-2..indd - Staywell Guam

This guide provides clear and comprehensive instructions on how to accurately fill out the SW15038-CHANGE OF STATUS FORM-2..indd for StayWell Guam. Follow the outlined steps to ensure that your information is submitted correctly and efficiently.

Follow the steps to complete your change of status form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Begin by filling out your last name, first name, and middle initial (M.I.). Make sure to include your email address and work phone number.
3. Indicate your marital status and sex. Provide your employer's name, date of birth in MM/DD/YY format, and social security number.
4. For dependent changes, specify any adjustments you wish to make. Note that additions must occur within 30 days of your dependent's eligibility.
5. Add or delete dependents as necessary, including their name, relationship, social security number, birthdate, and sex.
6. If you are adding a spouse, provide their employer's name. Additionally, list your previous health plan's name, effective date, and termination date.
7. For any class changes, specify the current medical class and the new class along with the effective date.
8. For miscellaneous changes, indicate any subscriber or dependent name changes, plan transfers, or dental coverage modifications.
9. If you need to cancel medical coverage for your family, provide the effective date and reason for cancellation.
10. Sign the form in the designated space, including the date you signed it.
11. Once you have filled out the form, save your changes, download, print, or share it as required.

Complete your SW15038-CHANGE OF STATUS FORM-2..indd online today to ensure your information is updated!