Get Health Insurance Questionnaire Form

Filling out the Health Insurance Questionnaire Form online can seem challenging at first, but with the right guidance, you can complete it confidently and accurately. This guide provides clear instructions for each section, ensuring you understand the required information.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to access the Health Insurance Questionnaire Form and open it in your preferred format for filling out.
2. Start by entering the company name in the 'Group Name' field. This information is critical for identifying the coverage request associated with your company.
3. Fill in the 'Address', 'City', 'State', 'Zip', and 'County' fields accurately to ensure your company's information is complete.
4. Provide a brief description of your business in the 'Business Description' field and include the corresponding 'SIC Code' for classification.
5. Indicate the 'Number of Years with Current Medical Carrier' and the 'Renewal Date', along with any percentage increase in rates, if applicable.
6. Enter the 'Total Number of Full-Time Employees' and the number of 'Employees Enrolling in Health Plan'. Specify the employer contribution percentages for employee and dependent coverage.
7. Answer the question regarding the number of medical carriers in the last five years and specify the 'New Hire Waiting Period'.
8. For each listed medical condition, indicate the number of employees and dependents affected. Be honest and precise, marking '0' for any conditions not applicable.
9. Proceed to address the additional detailed questions regarding surgeries, disabilities, pregnancies, and any medical claims exceeding $5000. Ensure to provide comprehensive answers.
10. Complete the current and renewal Medical insurance premium rates along with attaching a copy of your most recent premium bill where requested.
11. Finally, certify the information by providing a signature and the date, affirming that the completed form is accurate and complete.
12. Once finished, you can save your changes, download the form for your records, print it, or share it as required.

Start completing the Health Insurance Questionnaire Form online now to ensure your company's health insurance needs are met.