Get Application Disabled Subscriber

Filling out the Application Disabled Subscriber online is an essential process for ensuring that a dependent child is enrolled in health coverage as a person with a disability. This guide provides a step-by-step approach to completing the application accurately and efficiently.

Follow the steps to complete your application with ease.

1. Click 'Get Form' button to obtain the application form and open it in your editor.
2. In Part A, fill out your personal details, including your last name, first name, MI, and contact information. Be thorough to avoid any delays in processing.
3. Provide your dependent's information in the corresponding sections, ensuring accuracy in names, social security numbers, and medical record numbers.
4. Complete the Subscriber Questionnaire in Part A, paying special attention to questions regarding financial dependence and living arrangements. Attach additional sheets if necessary for explanations.
5. Gather and attach supporting documentation, including a list of your dependent’s average monthly living expenses, a copy of the first page of your most recent tax return, and any proof of income or government aid your dependent receives.
6. Ensure that Part B is completed and signed by a licensed medical doctor. This physician will provide necessary medical information regarding the dependent’s disability.
7. Review all sections of the application to confirm that all information is complete and accurate. Save your changes.
8. Once all sections are completed and required documentation is attached, you can finalize the process by submitting the application via the indicated mailing address or fax number.

Take the first step now and complete your application online for your dependent's health coverage.