Get Followme Health Application Form

Filling out the FollowMe Health Application Form online can streamline your application process for health coverage. This guide will provide you with clear, step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to complete the application form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin with Part A — General Information. Fill in details for both the Primary Applicant and Co-Applicant, including their first names, last names, addresses, cities, provinces, postal codes, and telephone numbers. Ensure accuracy to avoid any processing delays.
3. For additional contact information, specify how you can be reached, entering details for both applicants if necessary. Make sure to include an email address for more efficient communication.
4. Input the Date of Birth for both the Primary Applicant and Co-Applicant. Gender information is also required; please select the appropriate option.
5. Provide health card numbers and information about any group health plans currently held or recently ended, including employer names and insurance companies.
6. Move on to Part B — Dependents To Be Covered. Fill in the details for each dependent, including names, health card numbers, birth dates, and ages.
7. In Part C — Plan Choice, select the desired health plan level by marking the appropriate box (Basic, Enhanced, Enhanced Plus, or Premiere).
8. In Part D — Beneficiary Designation, provide beneficiary details, including names, relationships to applicants, and trustee information if applicable.
9. In Part E — Your Payment Method, select your preferred initial payment option and complete the relevant payment details accommodating for either pre-authorized debit or credit card.
10. Follow through Part F — Payment Information and Authorization, ensuring you accurately fill in bank or credit card information, including account numbers and signatures.
11. Read and acknowledge the privacy notice in Part G, ensuring a clear understanding of the confidentiality of your information.
12. Complete Part H — Declaration. All applicants must sign and date this section confirming the accuracy of the provided information.
13. Finally, review the completed form for accuracy. Users can save changes, download, print, or share the form as necessary.

Complete your FollowMe Health Application Form online today for a seamless health insurance application experience.