Get Anthem Employee Waiver Form 2014

Completing the Anthem Employee Waiver Form 2014 online is a straightforward process that ensures your health care choices are documented accurately. This guide provides you with step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the Anthem Employee Waiver Form 2014, allowing you to open it in your preferred online editor.
2. Begin with Section 1: Employee Information. Fill in your last name, first name, middle initial, street address (not a PO box unless rural), city, state, and ZIP code. Ensure you provide your email address and phone numbers, along with your employment status (part-time/full-time) and marital status.
3. Continue to complete the required fields, including your Social Security number, employer name, occupation/job title, hire date, and number of dependents, if applicable. Remember that Social Security numbers are necessary under CMS regulations.
4. Move to Section 2: Life Insurance Beneficiary. Enter the last name, first name, Social Security number, and relationship of your chosen beneficiary.
5. If you are choosing to decline or refuse any coverage, complete Section 3 by selecting the type of coverage you are waiving (medical, dental, vision, or life) and specify for whom the coverage is waived (yourself, spouse/domestic partner, or child).
6. Provide the reason for declining coverage as well as any required carrier information if covered by other plans. List any dependents to be waived and complete the acknowledgment statement indicating your understanding of the implications of waiving coverage.
7. Do not forget to sign and date the form, certifying that you are making this decision voluntarily and that your coverage options have been thoroughly explained.
8. Finally, save your changes and choose to download, print, or share the completed form, ensuring you retain a copy for your records.

Complete your Anthem Employee Waiver Form 2014 online today to ensure your health care needs are met.