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How to fill out the Dependent Addendum online
Filling out the Dependent Addendum is an important step when you have more than two dependents to include in your Health Plan Application. This guide provides clear instructions to help you navigate the form efficiently.
Follow the steps to complete the Dependent Addendum.
- Press the ‘Get Form’ button to access the Dependent Addendum, allowing you to begin filling out the necessary fields.
- In the first section, enter your applicant name, Social Security number, phone number, and the effective date in the specified format (mm/dd/yyyy).
- Proceed to the Dependent Information section. For each dependent (from 3 to 6), fill in the first name, last name, date of birth (mm/dd/yyyy), and Social Security number.
- Designate the middle initial (M.I.) for each dependent and select their relationship (Son or Daughter) as applicable.
- Provide the email address for each dependent and the details of their primary care physician, including name, street address, city/town, state, and ZIP code.
- Indicate whether each dependent is a current patient of the primary care physician by selecting 'Yes' or 'No.'
- After filling out all required fields for each dependent, review your entire form to ensure accuracy. Once completed, you can save changes, download, print, or share the form.
Complete the Dependent Addendum online to ensure all your dependents are covered!
addendum. n. an addition to a completed written document. Most commonly this is a proposed change or explanation (such as a list of goods to be included) in a contract, or some point that has been the subject of negotiation after the contract was originally proposed by one party. addendum - Legal Dictionary | Law.com law.com https://dictionary.law.com › Default law.com https://dictionary.law.com › Default
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