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Dependent Certification |
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Do you have a dependent nearing the limiting age of coverage?
If so, United Concordia will be automatically mailing a Dependent Certification form to you to determine if the dependent is eligible for an extension of coverage under the student or handicapped dependent clause of your plan.
Don't want to wait? Just complete this printable version of the Dependent Certification form. You can fill out this form electronically and then print it to mail or fax to United Concordia, and even save it to your computer for your records.
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| Dependent Certification |
| United Concordia Companies, Inc. |
| PO Box 69417 |
Harrisburg, PA 17106-9417
Fax Number: 1-800-329-9093
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Once United Concordia receives your completed form, extended coverage will be granted as appropriate per your plan. If the dependent qualifies for continued student dependent coverage, a follow-up Dependent Certification form will be sent to you approximately every 12 months, with coverage being extended as appropriate. If the dependent qualifies for handicapped dependent coverage, the recertification period will vary based on the nature of the disability and the prognosis provided by the physician. In either situation, it is important to make certain a current copy of the form is on file to ensure continued dependent coverage. |
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