HCi makes it easy to cover your dependants // Cover your dependants HCi dependant registration is easy! We make it easy to cover dependants in your HCi couples or family membership. This form can be used to register a new dependant or to make a student declaration to ensure your older dependants can remain covered. HCi dependant registration HCi family membership includes your natural, step and adopted children under 23 years, as well as those over 23 in certain circumstances. Once your children reach 18, you need to keep us informed of their eligibility each year by completing this form (one form per dependant). Alternatively, you can complete a pdf form and submit it with any supporting evidence within OMS. Your name(Required) First Family name Your member number(Required)Your mobile numberYour email address(Required) Enter email address Confirm email address Are you adding dependant? yes, and I have a family membership already yes, so please change me to a family membership no, I am updating/confirming details for a dependant aged 18 or older Your new dependant's details(Required)aged 22 or less, and is not married or in a de facto relationshipaged 23 to 31 (inclusive) and is a full time studentnot a full time student but is aged 23 to 31 (inclusive), is not married or in a de facto relationship, and lives with me.aged 32 or older, participating in the National Disability Insurance Scheme (NDIS) and holds an active NDIS Plan. They do not have to live with me and may have a spouse of their own.If you are adding a new baby, please provide evidence of the birth (eg a birth certificate). If we receive it within 2 months of the birth, the baby will have the same waiting periods as the member. Drop files here or Select files Accepted file types: jpg, pdf, png, Max. file size: 300 MB, Max. files: 2. I understand that a small additional premium is required in this instance, and I can contact HCi to find out how much.Dependant's name(Required) First name Family name Dependant's date of birth(Required) DD slash MM slash YYYY Dependant's mobile phoneDependant's email address (if over 18) HiddenStudent declarationWhere is your dependant studying?(Required) Course started on(Required) DD slash MM slash YYYY Course is due to be completed on(Required) DD slash MM slash YYYY Please attach a copy of registration/enrolment details from the educational institution.(Required) Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 512 MB, Max. files: 3. Note that cover will cease on the course completion date unless you provide additional information.Please attach a copy of your dependant’s NDIS registration or NDIS plan.(Required) Drop files here or Select files Accepted file types: pdf, jpg, png, Max. file size: 512 MB. Declarations(Required)• I declare that any dependants on this form are my children and meet one of the above eligibility categories. • I declare that all information provided on this form is accurate to the best of my knowledge and agree to inform HCi if any of these circumstances change. • I understand that my dependants aged 23 or older may be removed from my family membership if I do not register them each year, and that waiting periods may then apply to any claims they make. If relevant, I have provided the requested evidence to register my child as a student or NDIS participant. • I am the primary member or have the authority to act for the primary member. I have read HCi’s Privacy Policy. I agree to these declarations 74365
