Get Faxable Change Document - Assurant Employee Benefits

Filling out the Faxable Change Document for Assurant Employee Benefits is a straightforward process. This guide provides step-by-step instructions to ensure that you accurately complete the form online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'To' field, enter the fax number '888.208.2323'. This is where the form will be sent upon completion.
3. Fill in the 'From' section, providing your fax number, name of the policyholder, and email address.
4. If any of the information entered has changed, check the box provided.
5. In the 'Message' section, briefly describe the purpose of your fax submission.
6. Enter your certificate number, the date you are filling out the form, your telephone number, and the relevant policy number. Ensure that the policy number is accurate.
7. Indicate the number of pages you are submitting with this fax.
8. If you are reporting an employee termination or salary change, fill out the 'Employee Termination of Employment and Salary Changes' section. Provide the employee’s name, reason for termination, last day worked, effective date, and any new salary amounts.
9. If applicable, complete the 'Employee Name Change' section by providing the necessary information, including certificate number and old name.
10. If you are requesting a coverage change, fill that section accurately including any relevant details about dependents to add or delete.
11. Once all sections of the form are completed, review your information for accuracy.
12. Save any changes made, and depending on your needs, you can download, print, or share the form as necessary.

Complete your forms online to ensure timely processing of your requests.