Get Coverage For Legally Domiciled Adults (lda) - Fordham University - Fordham

This guide provides clear, step-by-step instructions on how to complete the Coverage For Legally Domiciled Adults (LDA) form for Fordham University's medical plan coverage. Whether you are a faculty member or administrator, you will find helpful tips to navigate the form effectively.

Follow the steps to successfully complete the LDA coverage form.

1. Press the ‘Get Form’ button to access the Coverage For Legally Domiciled Adults (LDA) form and open it in your preferred editor.
2. Begin by filling out your personal information in the employee information section, which includes your name, address, gender, and employee identification details.
3. Select your medical plan options if making any changes for 2011 by checking one box only from the provided options.
4. In the Category A LDA information section, enter the personal details of the individual you are enrolling as your LDA, including their name, social security number, relationship, date of birth, and gender.
5. Complete the Category B LDA information provided, if applicable, by filling in similar details for those qualifying under Category B.
6. Proceed to the flexible spending account plan options if relevant, detailing any annual contribution amounts for reimbursement of expenses.
7. Read and sign the employee authorization section, certifying that all information is true, accurate, and complete before submitting the form.
8. Finally, ensure all required documents are attached and submit the form to the Office of Human Resource Management by the specified deadline.

Take the next step to ensure your LDA coverage by completing the necessary forms online today.