Get Fl Fl-72000 2008

Filling out the FL FL-72000 form online can streamline the enrollment process for Humana's health, dental, life, and vision insurance plans. This guide provides step-by-step instructions to ensure that you accurately complete each section.

Follow the steps to successfully complete the FL FL-72000 form online.

1. Press the ‘Get Form’ button to download and access the FL FL-72000 form in an online editor.
2. Begin by entering the proposed effective date of the coverage at the top of the form.
3. Provide your company name, city, and state in the designated fields.
4. In the 'Enrollment Information' section, indicate your relationship to the person being covered (e.g., employee, spouse, child). Fill in your height and weight, as well as your last name, first name, and middle initial.
5. Select the gender of each individual listed and indicate if you wish to cover your dependent adult child(ren).
6. Complete the 'Employee Information' section, including the number of hours worked per week, social security number, street address, phone number, and email address.
7. Select your preferred language and fill in the date of birth for yourself and any dependents.
8. Indicate if the dependents are full-time students or persons with disabilities, providing a reason if applicable.
9. Fill in the group number, benefit number, and class/division where applicable, and select the appropriate coverage types for medical, dental, life, and vision plans.
10. Answer questions related to prior medical or dental coverage, and indicate if any additional coverage is currently in effect.
11. Complete the evidence of health status section only if applicable, providing information about any medical conditions or treatments.
12. If you choose to waive any coverage, check the appropriate boxes and provide reasons for declining.
13. Review the agreement section, confirming that all provided information is true and complete to the best of your knowledge.
14. Provide your signature and the date at the bottom of the form, as well as that of any legal representative if necessary.
15. After completing the form, you have the option to save changes, download, print, or share the completed FL FL-72000 form.

Start filling out your FL FL-72000 form online today to ensure timely enrollment.