Get Vision Plan Enrollment Application - University Of Arkansas At Little ... - Ualr

Filling out the Vision Plan Enrollment Application is an essential step for users looking to enroll in vision coverage through the University of Arkansas at Little Rock. This guide will provide clear, step-by-step instructions to help you complete the application efficiently and accurately.

Follow the steps to complete your enrollment application online.

1. Click the ‘Get Form’ button to obtain the Vision Plan Enrollment Application and open it in your preferred online editor.
2. Begin by checking the appropriate box to indicate your coverage selection. You can choose from options like 'Employee', 'Employee & Spouse', 'Employee & Child(ren)', or 'Employee, Spouse & Child(ren)'. Additionally, select either the 'Basic Plan' or the 'Enhanced Plan'. If no boxes are checked, you will be enrolled in the Basic Plan.
3. Specify the premium deduction method by selecting either 'Pre-tax' or 'Post-tax'.
4. If this is a new enrollment, fill in the 'Plan Option'. For removing ineligible dependents, select the appropriate boxes for a divorced spouse or a child over the age of 26.
5. If you are terminating coverage, indicate this in the appropriate section.
6. Next, provide your personal information in the 'Employee Information' section. Ensure that you print clearly and fill in your name, social security number, birth date, sex, with your home and work phone numbers.
7. Answer whether you or any of your dependents have other vision insurance by selecting 'Yes' or 'No'. If 'Yes', provide the policyholder's name and insurance company.
8. In the 'List All Eligible Family Members Below' section, enter details for all eligible family members being covered. Include first name, last name, birth date, and indicate if they are a full-time student. Mark whether you are adding or terminating coverage for each member.
9. Lastly, review your information for accuracy. Sign and date the application at the bottom of the form.
10. Once all sections are completed, save any changes made to the form. You can also choose to download, print, or share the completed application as necessary.

Take the next step towards securing your vision coverage by completing the application online today.