Form SI16119 (756494-A) Medical History Statement (Evidence of Insurability) - School Employees Benefits Board (Sebb) Program - Washington

What Is Form SI16119 (756494-A)?

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 SI16119?
A: Form SI16119 is the Medical History Statement (Evidence of Insurability) required for the School Employees Benefits Board (SEBB) Program in Washington.

Q: Who needs to fill out Form SI16119?
A: Employees participating in the SEBB Program in Washington need to fill out Form SI16119.

Q: What is the purpose of Form SI16119?
A: Form SI16119 is used to provide evidence of insurability for the SEBB Program in Washington.

Q: Is Form SI16119 specific to school employees?
A: Yes, Form SI16119 is specifically for school employees participating in the SEBB Program in Washington.

Q: What information is required on Form SI16119?
A: Form SI16119 requires information about your medical history and other relevant health-related details.

Q: Why is Form SI16119 important?
A: Form SI16119 is important because it helps determine the insurability of individuals participating in the SEBB Program in Washington.

Q: When do I need to submit Form SI16119?
A: You need to submit Form SI16119 when applying for coverage or during open enrollment periods in the SEBB Program in Washington.

Q: Do I need to keep a copy of Form SI16119?
A: Yes, it is advisable to keep a copy of Form SI16119 for your records.

Q: Who can help me with questions about Form SI16119?
A: Your employer or the SEBB Program in Washington can help you with any questions you may have about Form SI16119.