Get Osage Re Enrollment Form

Filling out the Osage Re Enrollment Form online is a straightforward process that ensures you can continue to receive your health benefits as a member of the Osage Nation. This guide will provide clear instructions to help you navigate each section with ease.

Follow the steps to complete your re enrollment form successfully

1. Click the ‘Get Form’ button to obtain the Osage Re Enrollment Form and open it in your preferred editor.
2. Begin by providing your personal information in the 'Tribal Member and Spouse Information' section. Enter your name as it appears on official documents, followed by your birthdate and tribal membership enrollment number, which is essential to establish your identity within the tribe. Indicate if your spouse is also enrolling by selecting 'Yes' or 'No'.
3. If there have been any changes to your contact information since your last enrollment, update your home address, email address, and daytime phone number. If there are no changes, proceed to the next section.
4. Complete the 'Member Dependent Information' section. For each dependent child under the age of 18 as of December 31, 2012, provide the required information, including name, gender, birthdate, and tribal membership enrollment number. Ensure that you designate a parent or guardian to whom the dependent benefits will be applied.
5. In the 'Authorization' section, review the statements carefully regarding your participation in the health plan. Confirm your enrollment and accuracy of the information provided. Last, sign and date the form to certify your agreement.
6. After you have completed the form, review all entries for accuracy. Upon ensuring everything is filled out correctly, you can save any changes made. Options to download, print, or share the form are available depending on your preferences for submission.

Take the next step and complete your Osage Re Enrollment Form online to ensure continued access to your health benefits.