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Get Premera Member Enrollment And Change Application Form
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How to fill out the Premera Member Enrollment And Change Application Form online
Completing the Premera Member Enrollment And Change Application Form online can streamline the enrollment process, ensuring that all necessary information is captured accurately. This guide provides step-by-step instructions to help users navigate through each section of the form smoothly.
Follow the steps to complete your application effectively.
- Click ‘Get Form’ button to access the Premera Member Enrollment And Change Application Form and open it in your designated editor.
- Begin by filling out the Group Information section. Enter the Group ID and Group Name as provided by your employer. Select the Reason for enrollment: New, Open Enrollment, or Change, and fill in the Employee date of hire and the date the employee entered the eligible class.
- Proceed to the Employee Information section. Here, the employee should enter their name (last, first, MI), home phone number, marital status, and home address. If the mailing address differs from the home address, include that as well.
- In the Enrollment Information section, select your Plan Choice and enter the Date of Event. List each member’s name as you would like it to appear on the ID card, specifying their gender and Social Security number. Also, provide their date of birth and select benefits as applicable.
- Indicate if any dependent has a different mailing address and provide that information if necessary. If a child over the dependent age limit is applying for coverage due to a disability, ensure the certification form is completed and attached.
- Address the question regarding previous health insurance coverage during the past three months. If applicable, provide the names of those covered and the duration of their previous coverage. Attach any necessary forms for additional coverage if applicable.
- The final step involves providing your signature. Confirm that all the information entered is accurate, and sign the form. Note the date of signing.
- After completing the entire form, you can choose to save any changes made, download the form for your records, print it out, or share it as necessary.
Complete your Premera enrollment application online today for a smoother process and prompt access to your benefits.
While Premera operates under the Blue Cross Blue Shield umbrella, they are not the same entity. Premera focuses on the Washington market and offers tailored services for its members. To make informed decisions about your health care, completing the Premera Member Enrollment and Change Application Form can be very beneficial.
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