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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HCA52-0030
for the current year.
Form HCA52-0030 Pebb Employee Enrollment / Change for Medical Only Groups - Washington
What Is Form HCA52-0030?
This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form HCA52-0030?
A: Form HCA52-0030 is the Pebb Employee Enrollment/Change form for Medical Only Groups in Washington.
Q: Who uses Form HCA52-0030?
A: Form HCA52-0030 is used by employees who want to enroll or make changes to their medical coverage in Washington.
Q: What is the purpose of Form HCA52-0030?
A: The purpose of Form HCA52-0030 is to facilitate enrollment or changes to medical coverage for employees in Washington.
Q: Are there any specific eligibility requirements to use Form HCA52-0030?
A: There may be specific eligibility requirements for using Form HCA52-0030. It is recommended to review the instructions and guidelines provided with the form.
Q: Is Form HCA52-0030 specific to a certain group or state?
A: Yes, Form HCA52-0030 is specific to Medical Only Groups in the state of Washington.
Q: Can Form HCA52-0030 be used for non-medical coverage changes?
A: No, Form HCA52-0030 is specifically designed for medical coverage changes only.
Q: Is there a deadline to submit Form HCA52-0030?
A: The deadline for submitting Form HCA52-0030 may vary. It is important to check with the employer or human resources department for the specific deadline.
Q: Can I make multiple changes on a single Form HCA52-0030?
A: Yes, multiple changes can be made on a single Form HCA52-0030 as long as they pertain to medical coverage.
Q: What should I do if I need assistance with Form HCA52-0030?
A: If you need assistance with Form HCA52-0030, it is recommended to contact your employer or human resources department in Washington.
Form Details:
- Released on August 1, 2021;
- The latest edition provided by the Washington State Health Care Authority;
- 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 HCA52-0030 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
Download Form HCA52-0030 Pebb Employee Enrollment / Change for Medical Only Groups - Washington
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