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Form HBEX411B Notification of Deceased by an Enrolled Member - California
What Is Form HBEX411B?
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 HBEX411B?
A: Form HBEX411B is the Notification of Deceased by an Enrolled Member.
Q: Who can use Form HBEX411B?
A: Form HBEX411B is specifically for use by enrolled members in California.
Q: What is the purpose of Form HBEX411B?
A: The purpose of Form HBEX411B is to notify the California Health Benefit Exchange of the death of an enrolled member.
Q: Is there a fee to submit Form HBEX411B?
A: No, there is no fee to submit Form HBEX411B.
Q: What information is required on Form HBEX411B?
A: Form HBEX411B requires information such as the name and contact information of the deceased member, their Social Security number, and the date of their death.
Form Details:
- Released on April 1, 2018;
- The latest edition provided by the Covered California;
- 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 fillable version of Form HBEX411B by clicking the link below or browse more documents and templates provided by the Covered California.
Download Form HBEX411B Notification of Deceased by an Enrolled Member - California
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