Get Metlife Enrollment Change Form

Filling out the Metlife Enrollment Change Form online is an essential process for managing your insurance coverage effectively. This guide provides clear, step-by-step instructions tailored to ensure a seamless experience.

Follow the steps to successfully complete your form online.

1. Press the ‘Get Form’ button to acquire the Metlife Enrollment Change Form and open it in your preferred online editing tool.
2. Complete the 'Group Customer Information' section by providing the name of your group customer or employer, group customer number, division, class, department code, date of hire, coverage effective date, original COBRA effective date (if applicable), and COBRA termination date (if applicable).
3. In the 'Your Enrollment Information' section, enter your name (first, middle, last), social security number, gender, address (street, city, state, zip code), employment status (employee or retiree), date of birth, job title, and basic annual earnings.
4. Select your enrollment type, which may include new enrollment, change in enrollment, or COBRA continuation. Specify your marital status (single or married) and employment type (salaried or hourly), along with hours worked per week.
5. If the enrollment is due to a qualifying event, enter the date of the event.
6. Review the coverage options and choose your desired levels for term life, dependent life insurance, disability income insurance, or dental insurance.
7. For dependent coverage, if applicable, provide the requested information for your spouse/domestic partner and/or child(ren), including their names, dates of birth, and gender.
8. Designate a primary beneficiary and, if necessary, a contingent beneficiary by providing their names, dates of birth, relationships, addresses, and share percentages.
9. Acknowledge the declarations by reading the provided information and sign the form to affirm that all information given is accurate.
10. Complete the payment authorization section by signing and dating to authorize your employer to deduct required contributions from your earnings.
11. After filling out the form, ensure all information is accurate. You can then save changes, download, print, or share the completed form as necessary.

Complete your Metlife Enrollment Change Form online today for a smooth enrollment experience.