Get Application To Add Dependent Up To Age 26

Filling out the Application to Add Dependent Up to Age 26 is a straightforward process that ensures your dependent can receive health coverage. This guide will help you navigate each section of the form with ease.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the application and open it for editing.
2. In the first section, clearly print the dependent's last name, first name, and middle initial. Ensure accuracy as this information is crucial for identification.
3. Provide the dependent's date of birth in the specified format. This helps verify the dependent's eligibility age.
4. List the dependent's social security number. Ensure this is accurate as it links to their identification in the healthcare system.
5. Fill out the dependent's address, including city, state, and zip code. Providing a complete address ensures proper processing.
6. Indicate your relationship to the dependent by checking the appropriate box (natural born child, adopted child, step-child, or foster child).
7. If the dependent has a different last name, attach a copy of their birth certificate.
8. Answer whether the dependent has other medical coverage by selecting 'YES' or 'NO'. If 'YES', fill in the additional details about the other carrier's name, policy number, effective date, and policy holder's name.
9. Indicate your relationship to the policy holder by selecting the appropriate option (self, spouse, parent, or guardian). Repeat this for dental and prescription coverage if applicable.
10. Sign and date the application at the bottom of the form to confirm that all information is accurately provided.
11. Make a copy of this application for each dependent you wish to add to your self and family coverage.
12. Submit the completed application to APWU Health Plan at the address provided, ensuring it is directed to the Enrollment Unit.

Take the next step in ensuring your dependent receives coverage by completing the Application to Add Dependent Up to Age 26 online today.