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How to use or fill out SEIU Local 1 2 Claim Form with Our Platform
- Click ‘Get Form’ to open the SEIU Local 1 2 Claim Form in the editor.
- Begin by entering your personal information in the designated fields, including your first, middle, and last name, as well as your address and date of birth.
- Indicate whether this is an initial or subsequent claim and provide details for any dependents if applicable. Ensure you fill in their names and dates of birth accurately.
- In the expense section, specify the type of expense incurred, including the name or D.I.N. of the drug supplier or pharmacy, along with the amount charged.
- Answer whether you have any other coverage that would pay a benefit for this claim by selecting 'Yes' or 'No'.
- Review the authorization statement carefully before signing. This confirms that you allow Global Benefits to process your claim using your personal information.
- Finally, add your signature and date at the bottom of the form before submitting it to Global Benefits via email or fax.
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What is the SEIU Local 1?
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