Get Humana Colorado Enrollment Form Pdf

Completing the Humana Colorado Enrollment Form is a straightforward process that can be done online. This guide provides step-by-step instructions to help you fill out each section of the form accurately.

Follow the steps to complete the form effectively.

1. Click 'Get Form' button to obtain the Humana Colorado Enrollment Form Pdf and open it in your preferred PDF editor.
2. Begin by filling in the Dental Group number and Benefit number, along with the Company name and Class/Division. Ensure that these fields are completed clearly.
3. Fill in the Proposed Effective Date in the MMDDYYYY format, followed by the Company city, State, and your Employee Information. This includes your last name, first name, middle initial, social security number, date of birth, phone number, gender, email address, street address, and zip code.
4. Indicate your employment status as full-time or retiree, and specify the number of hours worked per week if applicable. Provide the date of full-time hire if you are a full-time employee.
5. Answer the question regarding any disabilities. If applicable, provide the reason for the disability.
6. Input information for each dependent applying for coverage in the 'Dependent Information' section. This includes the last name, first name, middle initial, social security number, gender, date of birth, and relationship for each dependent.
7. Select the Coverage type by marking the relevant checkbox, and provide information about any individual or other group dental coverage within the past twelve months.
8. Complete the sections for Basic Life and Short-term Income Protection. Indicate whether you elect voluntary coverage and provide the names of primary and secondary beneficiaries along with the annual salary.
9. Review the Waiver section carefully if you are waiving any coverage. Indicate any reasons for declines and sign the agreement section, affirming the accuracy of all provided information.
10. Once all fields are accurately filled, you can save changes, download, print, or share the filled form as needed.

Start now to complete your Humana Colorado Enrollment Form online.