Get Trustmark A112-2512 2019-2025

Filling out the Trustmark A112-2512 form, also known as the Application for Waiver of Premium, is a crucial step in the claims process. This guide will provide you with comprehensive, step-by-step instructions to ensure that you complete the form accurately and efficiently online.

Follow the steps to fill out the form with ease.

1. Click the ‘Get Form’ button to access the Trustmark A112-2512 document and open it in your editor.
2. Begin by completing Section A, which requires the insured's information. Fill in your name, policy number, date of birth, social security number, address, phone number, and email address. Ensure accuracy as this information is essential for account verification.
3. Proceed to Section B to detail the claim information. Here, list the names and addresses of doctors consulted, dates of treatment, and the nature of your illness or injury. Remember to provide specific dates regarding when your illness was first noticed and when any accidents occurred.
4. In this section, also indicate whether you were at work when the injury occurred, the date you stopped working due to disability, and any expected return date to work. Also, document any benefits you are eligible to receive from various sources.
5. Next, navigate to Section C to manage expenses related to your insurance coverage. Choose whether you want Trustmark to withhold premiums for your benefits while receiving payments, or if you prefer to make payments yourself.
6. Complete any optional sections, such as the Consent for Use of Electronic Communication, to receive updates about your claim via text or email. This can enhance communication for your claim.
7. Finally, review all sections for completeness and accuracy. After ensuring that all details are correct, you will have the option to save your changes, download the form, print a hard copy, or share it as needed.

Begin filing your Trustmark A112-2512 online to ensure a smooth claims process.