Get Great West Life Group Coverage Change Form

The Great West Life Group Coverage Change Form is essential for plan members seeking to modify their group benefits. This guide will provide you with a clear and user-friendly approach to completing the form online, ensuring all necessary information is captured accurately.

Follow the steps to successfully fill out the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by reviewing the 'General Enrollment Information' section. Fill in your plan number, division number, plan sponsor, and your personal details, including your full name and plan member ID.
3. Proceed to the 'Reinstatement' section if applicable. Indicate the date you returned to work and the reason for reinstatement, ensuring you provide correct details as indicated.
4. In the 'Refusal of Benefits' section, clarify if you are declining certain benefits. Be sure to initial any corrections made in this section.
5. Complete the 'Addition of Group Health and/or Dental Benefits' section if you are applying for coverage due to a loss of spousal coverage. Provide the effective date of loss and specify the benefits impacted.
6. If you are changing dependant information, fill out the appropriate fields in the 'Dependant Information Change' section. This includes indicating whether you are adding or deleting a dependant, and providing their relevant information.
7. If you need to change your name as a plan member, utilize the 'Plan Member Name Change' section. Clearly write your former name and your new name.
8. To update your designated beneficiaries, complete the 'Beneficiary Designation Change' section, detailing all necessary information regarding new beneficiary allocations.
9. If opting out of group benefits, follow the directions provided in the 'Opting Out of all Group Benefits' section and confirm your understanding of the implications.
10. Review the 'Privacy' section to understand how your personal information will be handled.
11. Finally, ensure all declarations are signed and dated in ink. This is essential for processing your form.
12. Once all sections have been completed, you can save changes, download, print, or share the form as needed.

Begin the process to fill out your Great West Life Group Coverage Change Form online today.