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Get Wea Select Cobra Continued Group Coverage Application ...
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How to fill out the WEA SELECT COBRA Continued Group Coverage Application online
Completing the WEA SELECT COBRA Continued Group Coverage Application online is a straightforward process. This guide will provide you with clear, step-by-step instructions to help you accurately fill out the necessary information to ensure your coverage continues without delay.
Follow the steps to complete your application effectively.
- Click the ‘Get Form’ button to access the application form, which will open in an online editor.
- Provide the school district name at the top of the form.
- Fill in your employee information, starting with your last name, first name, middle initial, mailing address, home phone number, Premera ID number, city, state, and ZIP code.
- Indicate whether any dependents have a different mailing address by checking 'No' or 'Yes' and providing their name and address if applicable.
- Answer the question regarding any other coverage by selecting 'No' or 'Yes.' If 'Yes,' be sure to attach the Other Coverage Questionnaire form.
- Choose your WEA Select Medical Plan Selection by checking the box next to the plan you are currently enrolled in or plan to choose.
- Select your WEA Select Vision Plan if you have vision coverage. Again, ensure you select only the plans available to you.
- List all dependents you wish to cover by providing their names, genders, birth dates, and social security numbers. Make sure the names conform to the ID card space limitations.
- Confirm your understanding of the terms by reading the statement and providing your signature and date signed at the bottom of the form.
- If applicable, complete the section designated for use by your school district, including the COBRA effective date and all other details as required.
- Review the entire form for accuracy before proceeding. Save your changes, then download, print, or share the completed form as needed.
Complete your documents online to ensure your continued coverage.
Continuation of benefits refers to the ability to keep your health insurance benefits active despite a change in employment status. This safeguard offers individuals stability and peace of mind during transitions. Utilizing the WEA SELECT COBRA Continued Group Coverage Application can empower you to take control of your healthcare needs during this important period.
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