Form HCA20-0084 Sebb Extended Dependent Certification - Washington

What Is Form HCA20-0084?

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 HCA20-0084?
A: Form HCA20-0084 is the Sebb Extended Dependent Certification form specific to Washington state.

Q: What is the purpose of Form HCA20-0084?
A: The purpose of Form HCA20-0084 is to certify the eligibility of extended dependents who wish to receive health coverage through the Sebb program in Washington state.

Q: Who needs to fill out Form HCA20-0084?
A: Form HCA20-0084 needs to be filled out by extended dependents who are applying for health coverage through the Sebb program in Washington state.

Q: What information is required on Form HCA20-0084?
A: Form HCA20-0084 requires information about the extended dependent's relationship to the employee, proof of relationship, and their eligibility for other health coverage.

Q: When is the deadline to submit Form HCA20-0084?
A: The deadline to submit Form HCA20-0084 is typically specified by the Washington State Health Care Authority (HCA) or the employer's enrollment deadline.

Q: What happens after submitting Form HCA20-0084?
A: After submitting Form HCA20-0084, the Washington State Health Care Authority (HCA) will review the application and determine the extended dependent's eligibility for health coverage through the Sebb program.