Get Erb Form

Filling out the Erb Form online is a straightforward process designed to ensure you can easily enroll in or change your health benefits. This guide will provide you with a step-by-step approach to complete the form correctly.

Follow the steps to complete your Erb Form seamlessly.

1. Press the ‘Get Form’ button to access the Erb Form and open it in your preferred editor.
2. Begin with Section A, where you will identify your status. Choose either 'Employee' or 'Retiree' and indicate your reason for submission. Depending on your selection, follow the instructions that apply to your status.
3. If you are new to the benefits plan, select 'New Enrollment' and proceed to Section D. If reinstating or transferring from another agency, ensure to follow the prompts to Section C if applicable.
4. Complete Section B if you are changing your enrollment. Specify your reason for change, ensuring you adhere to the transfer period guidelines.
5. In Section C, if there are any family status changes, specify the nature of these changes, be it adding or dropping dependents, and complete the required fields.
6. Fill out Section D with your personal information, ensuring all required fields are complete. Include vital details such as your name, Social Security number, and address.
7. If applicable, complete Section E for spouse or domestic partner information, providing necessary supporting documentation.
8. In Section F, provide information about your family members who will be covered under the plan. Ensure this section is filled out accurately.
9. In Section G, clearly print the name of the health plan you are selecting, and indicate whether you want optional benefits.
10. Lastly, sign and date the form in Section H, certifying the accuracy of your application. If you are participating in the Buy-out Waiver Program, also complete Section I.
11. Save your changes, then download, print, or share the form as required to ensure submission.

Start filling out your Erb Form online today to ensure your health benefits enrollment is processed smoothly.