Get Employee Application - Assurant Employee Benefits

Filling out the Employee Application - Assurant Employee Benefits is a crucial step for employees to enroll in coverage. This guide provides a step-by-step approach to assist you in completing the online application accurately and efficiently.

Follow the steps to complete your online application successfully.

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Begin by providing your employee information. Fill in your last name, first name, and middle initial clearly. Ensure that you include your employer's name, group policy or participant number, and account number or bill group name.
3. Indicate your sex by selecting 'M' for male or 'F' for female. Next, input your job title or position, address, city, state, and zip code. Be attentive to your employee hire date, employment location, certification number, and the number of hours you work per week.
4. Provide your employee Social Security number and birthdate. Fill out your earnings, specifying how you are compensated (hourly, weekly, monthly, yearly, or other). If applicable, answer the questions regarding marital status and children.
5. If you are applying for dependent coverage, complete the dependent information section including the last name, first name, date of birth, gender, and relationship of each dependent.
6. Select the vision benefits you wish to enroll in. Options include Employee Vision, Dependent Vision for a spouse, child(ren), or family. Keep in mind that if you enroll, you will be responsible for paying all or a portion of the premium.
7. Before finalizing your application, read the certification statement carefully. Confirm that you understand the coverage information and provide your electronic signature along with the date.
8. Save your changes, and download a copy of your completed form. You can also print or share the document as needed.

Complete your Employee Application online today for efficient processing of your benefits.