Get Superimposed Major Medical Claim Form - Osaunion - Osaunion

Filling out the Superimposed Major Medical Claim Form can seem daunting, but this guide provides a clear, step-by-step approach to help you complete the form online with ease. Follow the instructions carefully to ensure all information is accurately submitted for your claim.

Follow the steps to successfully complete your claim form.

1. Click ‘Get Form’ button to obtain the Superimposed Major Medical Claim Form - OSAunion - Osaunion and open it for editing.
2. Begin by filling out Section A, Employee Information. Ensure you provide your social security number, indicate if you are active or retired, your date of birth, last and first name, address, city, state, ZIP code, health plan name, and type of plan. Mark whether you have prescription drug coverage and if there is other coverage.
3. Proceed to Section B, Patient Information, if the patient is other than the employee. Indicate their last name, first name, social security number, relationship to the employee, date of birth, and check if they are an unmarried dependent child age 19 or older.
4. If the claim is due to an accident or occupational illness/injury, fill out Section C. Provide details about the accident, the date it occurred, and describe the illness or injury.
5. Complete Section D, Member/Patient’s Signature and Release. Ensure you sign and date the form along with the patient’s signature if they are not a minor.
6. Wrap up by reviewing the completed form for accuracy. Save your changes, then you have the option to download, print, or share the form for submission.

Start filling out your Superimposed Major Medical Claim Form online today to ensure timely processing of your claim.