Get Vsdp Long Term Care Plan Authorization Of Coverage Retention - Varetire

This guide provides a step-by-step approach for filling out the VSDP Long Term Care Plan Authorization of Coverage Retention form online. This document is essential for individuals looking to maintain their long-term care coverage under the Virginia Sickness and Disability Program.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor. This action allows you to access the document needed to proceed with your application.
2. In Part A, provide your participant information. Input your first name, middle initial (if applicable), last name, and date of birth in the designated fields. Ensure that your address details are correct, including street, city, state, and ZIP code.
3. In Part B, choose your payment option for continued coverage. If you prefer electronic payments, select the Monthly Electronic Funds Transfer option and provide the name and address of your financial institution. Specify the account type — checking or savings — and attach the required documentation.
4. Alternatively, if you wish to receive direct billing, select one of the options for quarterly, semi-monthly, or annual billing. Make sure to choose only one of these options to avoid confusion.
5. Proceed to Part C, where you will need to sign to certify your decision to continue your coverage under the Virginia Sickness and Disability Long Term Care Plan. Input the date of your signature.
6. Review all the sections for accuracy. Once confirmed, save changes, download the document, print it, or share it as needed.

Complete your document online today to ensure continued coverage.