Get Wa Lifewise 013948 2019-2026

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.

1. Press the ‘Get Form’ button to obtain the WA LifeWise 013948 form and open it in your editor.
2. 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.
3. 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.
4. 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.
5. 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.
6. Ensure the subscriber signs the signature line to validate the form. This must be done before moving on to Section 3.
7. 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.
8. 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.