Get Boa Application - Eng Final.indd - Utah Department Of Health ... - Health Utah

This guide provides you with step-by-step instructions on how to successfully fill out the BOA Application - Eng FINAL.indd, a crucial form from the Utah Department of Health. Ensuring the application is completed accurately is essential for a smooth processing experience.

Follow the steps to efficiently complete the BOA Application.

1. Click the ‘Get Form’ button to access the BOA Application online and open it for completion.
2. Begin by filling out Section 1: General Information. Enter the employee's name, social security number, company name, and employer identification number. It is important that all fields are filled out to avoid delays.
3. For the health insurance options, answer questions A to D regarding health insurance availability and enrollment for the employee and any family members. Pay careful attention to the eligibility dates and coverage changes.
4. Move on to Section 2: Least Expensive Plan. Here you will address whether the employee must enroll for dependent coverage, the start date of that coverage, and complete the cost chart regarding different coverage types. Distinguish between employee-only, employee plus spouse, employee plus child, and family coverage costs.
5. Complete Section 3: Employee’s Choice of Health Plan by providing the chosen insurance company and plan name, and answering specific questions regarding the coverage, including deductibles and benefit levels.
6. Fill out the chart for costs similar to Section 2 if they differ, and respond to any questions regarding children's enrollment in dental plans.
7. Finally, Section 4: Signature requires the representative of the Human Resources department to certify the information. This includes signing, printing their name, providing their title, and a contact phone number.
8. Once all sections of the form are completed, you can save changes, download, print, or share the form as needed. Ensure to return the completed form to the designated Utah Department of Health address or fax number provided.

Complete your BOA Application online today to ensure timely processing.