Form HBEX411A Notification of Deceased - California

What Is Form HBEX411A?

This is a legal form that was released by the Covered California - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form HBEX411A?
A: Form HBEX411A is the Notification of Deceased form in California.

Q: Who needs to fill out Form HBEX411A?
A: Form HBEX411A needs to be filled out by the legal representative of the deceased individual in California.

Q: What is the purpose of Form HBEX411A?
A: Form HBEX411A is used to notify the California Health Benefit Exchange of an individual's passing, in order to terminate their health coverage.

Q: Do I need to submit any documents with Form HBEX411A?
A: Yes, you need to submit a certified copy of the deceased individual's death certificate along with Form HBEX411A.

Q: What happens after I submit Form HBEX411A?
A: After submitting Form HBEX411A, the California Health Benefit Exchange will terminate the health coverage of the deceased individual.

Q: Are there any deadlines for submitting Form HBEX411A?
A: Yes, you are required to submit Form HBEX411A within 60 days of the individual's death.

Q: Is there any fee for filing Form HBEX411A?
A: No, there is no fee for filing Form HBEX411A.

Q: Can I still contact the California Health Benefit Exchange after submitting Form HBEX411A?
A: Yes, you can still contact the California Health Benefit Exchange if you have any questions or need assistance after submitting Form HBEX411A.