Transcription of Request for Certification of Disabled Dependent
{{id}} {{{paragraph}}}
Example: biology
Request for Certification of Disabled Dependent
** The attending physician s statements regarding disability status are necessary and important for Premera; however, Premera is not bound by the physician s conclusion. 008758 (09-01-2019) Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association Disabled Dependent Certification PLEASE READ CAREFULLY The Disabled Dependent Certification form is used to determine if your adult Dependent child meets the plan s eligibility requirements for continued coverage after the age limit is reached. IMPORTANT NOTE The inability to find employment or a reduction in work force is, of themselves, NOT evidence of eligibility for continuation of coverage. INSTRUCTIONS You or your physician may submit the information requested in this Disabled Dependent Certification form.
Membership & Billing, MS 737 PO Box 3048 Spokane, WA 99220 Request for Certification of Disabled Dependent An Independent Licensee of the Blue Cross Blue Shield Association
Loading..
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document:
Related search queries
Certification Guide, Certification, Certified, Licensed Clinical Social Worker, Peer Specialist Training and Certification Programs, Peer Specialist . Training and Certification Programs, Social, York State Estate Tax Certification, Certification of 50 Hours Behind, Florida Certified Nursing Assistant . Examination, Certified Payroll Specialist