Get Online Rice Application Form

Filling out the Online Rice Application Form can be a straightforward process if you follow the right steps. This guide will provide you with detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the Online Rice Application Form online:

1. Press the ‘Get Form’ button to retrieve the form and open it in your editor.
2. Enter your name in the format (Last Name, First, Middle Initial) in the designated field.
3. Provide your Social Security number in the format __ __ __ - __ __ - __ __ __ __.
4. Select your gender by marking the appropriate box for Male or Female.
5. Input your home telephone number, ensuring to include the area code.
6. Fill in your street address, along with your city, state, and zip code.
7. If the applicant is not the employee, complete the sections regarding the employee's details, including their name and Social Security number.
8. Enter your date of birth using the format MM/DD/YYYY.
9. Provide the employee's date of hire using MM/DD/YYYY.
10. Fill in the work telephone number for the employee.
11. Complete the employee's date of birth in MM/DD/YYYY format.
12. Indicate if the applicant is an Employee, Employee's Parent or Grandparent, Employee's Spouse, or Spouse's Parent or Grandparent by checking the appropriate box.
13. Choose a plan option by marking either Plan 1, Plan 2, Plan 3, or Plan 4.
14. Select a facility monthly benefit amount by checking one option, either $1,000, $2,000, $3,000, $4,000, $5,000, $6,000, $7,000*, $8,000*, or $9,000*.
15. Specify the facility benefit duration by selecting 3 Years, 6 Years, or Unlimited Duration*.
16. If applicable, select your payment method, either Monthly Automatic Payments or Billed directly, and fill in corresponding details.
17. Read the caution statement and ensure you understand it before proceeding.
18. Enter the premium amount in the designated space, transferring this from your calculation on the rate sheet.
19. Sign the application as the applicant, noting the date of signature.
20. If applicable, the employee must also sign, providing the date of their signature.
21. Make sure to keep a copy for your records and mail any required signature forms to the appropriate entity.

Complete your Online Rice Application Form online today for efficient processing.