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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 HCA20-0123
for the current year.
Form HCA20-0123 Sebb Premium Payment Plan Election / Change - Washington
What Is Form HCA20-0123?
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 HCA20-0123?
A: Form HCA20-0123 is the Sebb Premium Payment Plan Election/Change form for Washington.
Q: What is the purpose of Form HCA20-0123?
A: The purpose of Form HCA20-0123 is to elect or change the Sebb Premium Payment Plan in Washington.
Q: Who needs to fill out Form HCA20-0123?
A: Any individual in Washington who is eligible for the Sebb Premium Payment Plan and wants to elect or change their plan needs to fill out Form HCA20-0123.
Q: How do I fill out Form HCA20-0123?
A: Form HCA20-0123 requires you to provide personal information, select your desired Sebb Premium Payment Plan, and sign the form. Follow the instructions provided on the form.
Q: Is there a deadline for submitting Form HCA20-0123?
A: Yes, there is a deadline for submitting Form HCA20-0123. The specific deadline will be provided by your employer or the Washington Health Care Authority.
Q: What happens after submitting Form HCA20-0123?
A: After submitting Form HCA20-0123, your Sebb Premium Payment Plan election or change will be processed, and you will be notified of any further steps or updates.
Q: Can I make multiple changes to my Sebb Premium Payment Plan using Form HCA20-0123?
A: Yes, you can make multiple changes to your Sebb Premium Payment Plan using Form HCA20-0123. Each change will require a new form submission.
Form Details:
- Released on July 1, 2022;
- 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 HCA20-0123 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
