Meritain form 2025

1. Click ‘Get Form’ to open the meritain form in the editor.
2. Begin by filling in your personal details, including your name, date of birth, and member ID if you have one. This information is crucial for identifying your coverage.
3. Indicate whether you or any dependents have other health coverage by selecting 'YES' or 'NO'. If 'YES', proceed to complete the relevant sections on the other side of the form.
4. For each type of other insurance coverage, specify the type (Medical, Dental, Vision) and provide details such as the insurance company name, policy holder's name and birthdate, effective and termination dates of coverage.
5. If applicable, fill out Medicare information including Medicare ID number and effective dates. Ensure all family members covered under these plans are listed with their relation to the policy holder.
6. Finally, review all entered information for accuracy before submitting. You can take a picture of the completed form and email it to forms.direct@meritain.com or fax it to 1.716.541.6672.

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