Get Request To Decrease Fund Coverage - Kansas Health Care ...

Filling out the Request To Decrease Fund Coverage form is an important step for health care providers looking to adjust their coverage limits. This guide provides clear instructions to help you successfully complete the form online.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in the document editor.
2. Begin by completing Section I - Health Care Provider Information. Enter your full name, residence address, city, state, zip code, professional designation, and your license, registration, or certification number.
3. In Section II, state your present fund coverage limits. You will see options such as $300,000/$900,000 or $800,000/$2,400,000. Indicate the lower fund coverage limits you are requesting.
4. Provide reasons for your request to decrease the coverage limits in the designated space. If necessary, attach additional paper.
5. Specify the effective date for the lower limits. You can choose either the date of board approval or a date subsequent to the approval, which you must provide.
6. Review the understanding statement about the effectiveness of the requested changes and complete it as required.
7. Authorize adjustments to your fund surcharge payment and indicate how refunds should be handled, either to yourself or to another party.
8. Finally, sign and date the form at the bottom.
9. Once completed, you can save changes, download, print, or share the form as necessary.

Take the next step in managing your health care fund coverage by completing the form online today.