Get Gg011364 Form

Completing the Gg011364 Form, also known as the Group Insurance Enrollment and Record Form, is a straightforward process that allows users to enroll in various insurance coverages. This guide provides step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to successfully complete the Gg011364 Form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the planholder name (company name) and the group plan number. Ensure all details are accurate.
3. Provide your personal information, including your full name, birth date, social security number, and contact details such as your address and telephone number.
4. Indicate your employment details, including your occupation, date of full-time employment, marital status, and hours worked per week.
5. Select the insurance coverages you wish to enroll in under the employee coverage section. Options may include life, major medical, dental, and short-term disability among others. Fill out any requested amounts for optional coverages.
6. If enrolling dependents, provide the names and details of each dependent including their relationship to you, sex, social security number, and birth date. Also, indicate if any of the children are adopted.
7. Complete the employee beneficiary designation section if you are enrolling for life insurance. Include the full name and relationship of the beneficiary.
8. Review the refusal of insurance section if you are declining certain coverage options. Provide information about other insurance policies if applicable.
9. Sign and date the form at the designated sections. If required, include a witness's signature.
10. After completing the form, you can save changes, download, print, or share the form as required.

Start the process of enrolling in your group insurance by completing the Gg011364 Form online today.