Get Statement Of Health Application - State Of Illinois - State Il

Completing the Statement Of Health Application - State Of Illinois online can be straightforward with the right guidance. This guide offers detailed step-by-step instructions to ensure that you accurately fill out the form, providing the necessary information for your application.

Follow the steps to complete your application successfully.

1. Press the ‘Get Form’ button to access the Statement Of Health Application. This will enable you to open the form in your preferred editing tool.
2. Begin by entering your employee information in the designated fields. Provide your first name, middle initial, last name, street address, date employed, member status, occupation, height, weight, and date of birth. Ensure that you also include your social security number and contact details.
3. Indicate the total insurance desired by checking the appropriate boxes for dependent life, optional life, and spouse life coverage if applicable. Review the age eligibility requirements for coverage.
4. If applicable, complete the spouse information section with the same details requested for the employee, including the spouse's date of birth and social security number.
5. Fill out the dependent child(ren) information section if you are applying for dependent coverage. Input the names, dates of birth, and social security numbers for each child.
6. Answer the health questions honestly for yourself, your spouse, and your children if applicable. Provide details for each question as required.
7. If you have additional health information to provide, specify details in the additional health information section, including names of doctors or hospitals and reasons for consultations.
8. Sign and date the application on the reverse side, ensuring that you and your spouse, if applicable, provide your signatures and complete the contact information fields.
9. After completing the form, review all entries for accuracy. Once confirmed, you can save your changes, download a copy, print the form, or share it as needed.

Take action now and complete your Statement Of Health Application online.