Get Benefitmall Employee Election Form

This guide provides clear and concise instructions on how to complete the Benefitmall Employee Election Form online. By following these steps, users can ensure accurate submission and take full advantage of their benefits.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to access and open the Benefitmall Employee Election Form in the designated editor.
2. Begin by filling in your personal information, including your last name, first name, middle initial, and social security number. Make sure to provide accurate details to avoid processing delays.
3. Indicate your employer's information, including whether they have 20 or more employees, and provide the employer's street address, city, state, and zip code.
4. Complete the demographic section by providing your date of birth, contact information, and details about your employment status, including full-time or part-time status.
5. If applicable, fill in the Medical, Dental, and Vision Plan sections by selecting your desired coverage options and providing the necessary carrier and plan type information.
6. Fill out the Life Insurance section with the beneficiary information if coverage is offered. Ensure that the relationship and other details are correctly entered.
7. Complete the Other/Prior Health Insurance section if you or your dependents have coverage with another insurer. Be thorough in your responses to ensure proper enrollment.
8. Review the certification section and provide your signature, along with the date, to confirm that all information is accurate and complete.
9. Once all sections are completed, you can save changes, download a copy, print it out for your records, or share the form as needed.

Complete your Benefitmall Employee Election Form online today to ensure your benefits are activated smoothly.