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Form ODM03749 Authorization for Certificate of Group Health Plan Coverage - Ohio
What Is Form ODM03749?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is ODM03749?
A: ODM03749 is a form used in Ohio to authorize the release of certificate of group health plan coverage.
Q: What is a certificate of group health plan coverage?
A: A certificate of group health plan coverage is a document that provides information about an individual's health insurance coverage within a group health plan.
Q: Why would someone need to fill out ODM03749?
A: Someone would need to fill out ODM03749 to authorize the release of their certificate of group health plan coverage to a designated recipient or organization.
Q: Who is this form applicable to?
A: This form is applicable to individuals in Ohio who need to authorize the release of their certificate of group health plan coverage.
Form Details:
- Released on July 1, 2014;
- The latest edition provided by the Ohio Department of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form ODM03749 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
Download Form ODM03749 Authorization for Certificate of Group Health Plan Coverage - Ohio
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