Get Safeway Benefit Election Form Pdf 2020-2025

Filling out the Safeway Benefit Election Form Pdf online is essential for making informed decisions about your long-term care coverage. This guide offers clear, step-by-step instructions to assist you in completing the form efficiently and accurately.

Follow the steps to fill out the form correctly

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your personal information including your name, Social Security number, and date of birth in the provided fields.
3. Specify your gender and date of hire by selecting the appropriate options.
4. Fill in your home and work telephone numbers, along with your street address, city, state, and zip code.
5. Indicate whether this is a change to existing coverage by selecting ‘Yes’ or ‘No’.
6. Circle the type of applicant you are: Parent or Grandparent, Sibling, or Child.
7. Choose your desired plan by checking one of the options for the Long Term Care plans.
8. Select your Facility Monthly Benefit Amount by checking one of the given amounts.
9. Choose the Facility Benefit Duration by selecting the duration that best meets your needs.
10. Complete the calculation for your premium as instructed, using the rate sheet provided.
11. Read the disclosures carefully and ensure that you understand the terms before proceeding.
12. Sign the form in the designated areas for the Applicant and Employee, adding the date next to each signature.
13. Save your changes and choose to download, print, or share the completed form as needed.

Complete the Safeway Benefit Election Form Pdf online to ensure your long-term care needs are well managed.