Clover's Group

Insurance, Documents and Expenses

Faith · Hope · Love · God's Grace

Last updated: ____________

Condensed Guide

Insurance, Documents and Expenses

Coverage, where every paper lives, and a monthly expense tracker.

3 pages · ~20 min · Prints on ≤ 3 Letter pages

CLOVER’S GROUP

Faith · Hope · Love · God’s Grace

Do not enter Social Security numbers, passwords, banking or full account numbers here. Store this printout in a safe place.

Insurance & benefits

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Medicare

Plan name

Member ID (last 4 only)

Phone

Portal / website

Effective date

Renewal date

Notes / authorization details

Medicaid

Plan name

Member ID (last 4 only)

Phone

Caseworker

Effective date

Renewal date

Notes / authorization details

Private / employer + LTC + VA + Rx + Other

Plan name

Member ID (last 4 only)

Group number

Phone

Carrier

Policy #

Phone

Benefits + waiting period + claim notes

VA benefit type (aid & attendance, health, etc.)

VA contact

Phone

Prescription plan

Phone

Other assistance (foundations, discount programs)

Where the paper copies are kept

Important documents locator

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Documents

Documents

Document 1

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 2

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 3

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 4

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 5

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 6

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 7

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 8

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 9

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes

Document 10

Document (ID, insurance card, advance directive, DPOA, living will, will/trust, guardianship, marriage cert, military records, insurance policies, property info, burial wishes, key contacts, etc.)

Location

Primary holder

Date of document

Notes