Get Peracare Enrollment/change Form Pre-medicare Coverage ... - Coloradomesa

Navigating the PERACare Enrollment/Change Form for Pre-Medicare Coverage is essential for ensuring you receive the right health benefits. This guide provides step-by-step instructions to assist you in accurately completing the form and making necessary changes to your coverage.

Follow the steps to successfully complete your enrollment/change form.

1. Press the ‘Get Form’ button to retrieve the document and open it for editing.
2. Fill in your personal information, including your full name, date of birth, telephone number, and email address. Indicate whether you wish to sign up for electronic delivery of PERA information.
3. Sign the certification section, confirming that the provided information is accurate and that you understand the enrollment process. Include the date.
4. Specify your desired effective date for enrollment or changes in coverage, ensuring it is applicable to your retirement date.
5. For dependent enrollment, fill out the names, dates of birth, and social security numbers for your spouse and any children under age 65.
6. Select the type of health plan you wish to enroll in by checking the appropriate box and circling your chosen health care coverage level and plan.
7. For dental coverage, follow the same process as the health plan selection, indicating your desired coverage level and plan.
8. Similarly, select your vision plan by checking the appropriate box and circling your desired coverage level.
9. After completing all sections, ensure that you have accurately filled in all fields. You can save changes, download, print, or share the form as needed.

Complete your enrollment/change documents online to secure your benefits today!