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Apply for over-age dependent coverage

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How to make this change

Use this form to apply for coverage for a child who is no longer a minor but is fully dependent on you financially.

  1. Print this form and complete sections 1 to 3. Remember that you need to attach your child’s most recent education assessment.
  2. Ask your child’s doctor to complete section 4.
  3. Once completed, mail it to the address on the form.

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