ODM03748 - Certificate of Group Plan Health Coverage - Ohio 2026

1. Click ‘Get Form’ to open the ODM03748 in the editor.
2. Begin by filling in the 'Office Name', 'Address', 'City', 'State', and 'Zip Code' for your health plan provider at the top of the form.
3. Next, enter your personal details including 'Participant Name', 'Address', and 'City'. Ensure accuracy as this information is crucial for your health coverage verification.
4. In the section labeled 'INFORMATION ABOUT YOUR CERTIFICATE OF GROUP HEALTH PLAN COVERAGE', read through the instructions carefully. This section outlines when you may need this certificate.
5. Fill out participant details under 'PARTICIPANT ONE', including their name, Medicaid ID Number, and Date of Birth. Repeat this for additional participants if necessary.
6. Indicate whether the participant(s) have at least 18 months of creditable coverage by selecting ‘Yes’ or ‘No’. Provide dates for when coverage began and ended if applicable.
7. Review all entered information for accuracy before saving or exporting your completed certificate. Utilize our platform’s features to sign and share it securely.

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