DISABLED DEPENDENT CERTIFICATION PLEASE READ CAREFULLY The Disabled Dependent Certification form is used to determine if your adult dependent child meets the plans' eligibility requirements for continued.
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How to fill out the WA LifeWise 013948 online
The WA LifeWise 013948 form, known as the Disabled Dependent Certification, is essential for determining if an adult dependent child qualifies for continued coverage after reaching the eligibility age limit. This guide provides step-by-step instructions to help users navigate the process clearly and effectively.
Follow the steps to complete the WA LifeWise 013948 form accurately.
- Press the ‘Get Form’ button to obtain the WA LifeWise 013948 form and open it in your editor.
- Begin by filling out Section 1 with the subscriber's information, including the full name, subscriber ID number, group number, address, city, state, zip code, and telephone number.
- Proceed to Section 2 to enter the dependent's information. Fill in their full name, marital status, sex, date of birth, relationship to the subscriber, address (if different), nature of disability, and date of disability.
- Indicate whether the dependent currently has other/additional health insurance. If yes, provide the necessary details, including the other insurance ID number and customer service number.
- In the Social Security Disability or Legal Guardianship supporting documents section, answer whether the dependent has been declared disabled by the Social Security Administration, and also if the dependent has been placed in legal guardianship by a court order. Attach any required documents as specified in the form.
- Ensure the subscriber signs the signature line to validate the form. This must be done before moving on to Section 3.
- In Section 3, the attending physician must complete and sign the necessary fields, certifying the dependent's condition. Provide a comprehensive medical proof of the disability.
- Finally, review the form to ensure all sections are complete. You can then save changes, download, print, or share the completed form.
Complete your WA LifeWise 013948 form online today to ensure your dependent's coverage needs are met.
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Is Washington HealthplanFinder legitimate?
Tips for avoiding scams The only official web address for the online marketplace is .wahealthplanfinder.org. Any other site with a variation on the name or with an address that ends in “. net” or “.com” is not the state's official marketplace.
How do I contact LifeWise Washington?
Customer service For member benefits, payment, and provider network questions. Call 800-817-3056, Monday through Friday, 8 a.m.-6 p.m. PT. Contact LifeWise lifewise.com https://.lifewise.com › resources › contact-us lifewise.com https://.lifewise.com › resources › contact-us
How to cancel Washington state Medicaid?
Phone: Call the HCA Medical Assistance Customer Service Center at 1-800-562-3022. Email: askmagi@hca.wa.gov. Paper: Send a request to cancel coverage to: HCA-MEDS, PO Box 45531, Olympia WA 98504.
Is LifeWise owned by Premera?
Premera is a non-profit company that offers health plans under a family of companies. These companies include Premera Blue Cross, Premera Blue Cross HMO, LifeWise Health Plan of Washington, and LifeWise Assurance company. Provider Networks Guide - Premera Blue Cross premera.com https://.premera.com › documents premera.com https://.premera.com › documents
Is LifeWise part of Premera?
Premera is a non-profit company that offers health plans under a family of companies. These companies include Premera Blue Cross, Premera Blue Cross HMO, LifeWise Health Plan of Washington, and LifeWise Assurance company.
How do I contact LifeWise Health Plan of Washington?
Customer service For member benefits, payment, and provider network questions. Call 800-817-3056, Monday through Friday, 8 a.m.-6 p.m. PT.
How do I cancel LifeWise?
What if I need to cancel my plan? If you purchased your plan directly from LifeWise, you can call customer service at 800-817-3056. If you purchased your plan from Washington Healthplanfinder, please call their customer support at 855-923-4633. You cannot cancel your plan by calling LifeWise customer service. Pay Your Monthly Bill | LifeWise lifewise.com https://.lifewise.com › pay-my-bill lifewise.com https://.lifewise.com › pay-my-bill
What is the payer ID for LifeWise?
Electronic Data Interchange (EDI) Call 800-435-2715 if you have questions about our electronic claims clearinghouse. To submit claims electronically, use 91049 as the payer ID. Contacts - LifeWise Assurance Company lifewiseac.com https://student.lifewiseac.com › provider › contacts lifewiseac.com https://student.lifewiseac.com › provider › contacts
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