Form SI16119 Medical History Statement for Late Entrants - South Carolina

What Is Form SI16119?

This is a legal form that was released by the South Carolina Public Employee Benefit Authority - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form SI16119?
A: Form SI16119 is the Medical History Statement for Late Entrants in South Carolina.

Q: Who needs to fill out Form SI16119?
A: Late entrants in South Carolina need to fill out Form SI16119.

Q: What is the purpose of Form SI16119?
A: The purpose of Form SI16119 is to provide information about the medical history of late entrants in South Carolina.

Q: Is Form SI16119 required for all late entrants in South Carolina?
A: Yes, Form SI16119 is required for all late entrants in South Carolina.

Q: What information is required on Form SI16119?
A: Form SI16119 requires information about the medical history of the late entrant, including any pre-existing conditions.

Q: Are there any fees associated with submitting Form SI16119?
A: No, there are no fees associated with submitting Form SI16119.

Q: Is it mandatory to provide all the requested information on Form SI16119?
A: Yes, it is mandatory to provide all the requested information on Form SI16119.

Q: Who should I contact if I have questions about Form SI16119?
A: You can contact the South Carolina Department of Insurance for any questions about Form SI16119.