12. Health Insurance Form – Read the instructions for filling out a health insurance form.

Reading Section Activity: Health Insurance Form

Topic: Understanding Instructions for Filling Out a Health Insurance Form

Objective: Help the student practice reading comprehension by interpreting the instructions provided for completing a health insurance form.

Step 1: Reading Passage – Health Insurance Form Instructions

Instructions for Completing the Health Insurance Form

1. Personal Information:
   • Fill out your full name, date of birth, and address in the designated fields.
   • Ensure that your name matches the name on your official identification.
2. Policy Information:
   • Enter your health insurance policy number. This can be found on your insurance card.
   • Specify the type of coverage you have (individual or family).
3. Medical History:
   • Provide details of any pre-existing medical conditions.
   • List any medications you are currently taking, including dosage and frequency.
4. Emergency Contact:
   • Fill in the name and phone number of a person to contact in case of an emergency.
   • This should be someone who can make decisions regarding your health care.
5. Signature and Date:
   • Sign the form at the bottom and write the date of completion.
   • Your signature confirms that all information provided is accurate and complete.
6. Submission:
   • Submit the completed form to your insurance provider either online or via mail.
   • Keep a copy of the form for your records.

Step 2: Comprehension Questions

After reading the instructions for the health insurance form, answer the following questions based on the details provided.

Multiple Choice Questions

1. What is the first section of the health insurance form?
   a) Medical History
   b) Signature and Date
   c) Personal Information
   d) Policy Information
2. Where can you find your health insurance policy number?
   a) On your ID card
   b) On your birth certificate
   c) On your medical history form
   d) On your emergency contact form
3. Who should you list as an emergency contact?
   a) Your doctor
   b) A family member or close friend
   c) Your insurance agent
   d) A co-worker
4. What must you do at the end of the form?
   a) Submit it online only
   b) Leave it unsigned
   c) Sign the form and date it
   d) Rewrite the entire form
5. Why should you keep a copy of the completed form?
   a) To give it to your doctor
   b) For future reference
   c) To send it to your employer
   d) To share on social media

Short Answer Questions

6. What information is required under “Personal Information”?
   (Write your answer below)
7. What should you include in the “Medical History” section?
   (Write your answer below)
8. What is the purpose of the “Emergency Contact” section?
   (Write your answer below)
9. How can you submit the completed health insurance form?
   (Write your answer below)
10. What does signing the form signify?
    (Write your answer below)

Step 3: Answer Key

1. c) Personal Information
2. a) On your ID card
3. b) A family member or close friend
4. c) Sign the form and date it
5. b) For future reference
6. The “Personal Information” section requires your full name, date of birth, and address.
7. In the “Medical History” section, you should include details about any pre-existing medical conditions and a list of any medications you are currently taking.
8. The purpose of the “Emergency Contact” section is to provide a name and phone number of someone who can make decisions about your health care in case of an emergency.
9. You can submit the completed health insurance form online or via mail.
10. Signing the form signifies that all the information provided is accurate and complete.

Step 4: Vocabulary & Definitions

Here are some difficult words and phrases from the instructions:

1. Pre-existing: A condition that existed before the start of a new insurance policy.
   • Example: “Patients with pre-existing conditions may face higher insurance premiums.”
2. Policy number: A unique number assigned to an insurance policy that identifies the coverage.
   • Example: “Make sure to write your policy number correctly on the claim form.”
3. Emergency contact: A person designated to be contacted in case of an emergency situation.
   • Example: “Please provide an emergency contact who can make medical decisions for you.”
4. Submission: The act of sending a completed document to a relevant party for processing.
   • Example: “The submission of your application must be done before the deadline.”
5. Accurate: Correct and precise without any mistakes.
   • Example: “Please ensure that all information on the form is accurate.”

Step 5: Selfie Assignment

Assignment:
Record a short video (1-2 minutes) explaining how you would fill out a health insurance form based on the instructions provided. Discuss what information you would include in each section and why it is important to ensure the accuracy of your information.