Get Application For Group Coverage - Great-west Life

Filling out the APPLICATION FOR GROUP COVERAGE from Great-West Life is essential for accessing your group benefits. This guide provides clear and detailed instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to obtain the application form in an editable format.
2. Complete the plan sponsor section. This section is intended for the plan administrator's input, so ensure you provide the plan number, division number, benefit class, plan sponsor, and member ID accurately.
3. Fill out your personal information in the Plan Member Information section. This includes your last name, first name, middle initial, date of birth, mailing address, and employment details.
4. Indicate your gender and provide details regarding your spouse and dependants. Be sure to answer whether you have a spouse and how many dependants you have.
5. If applicable, complete the Refusal of Benefits section. Here, you can decline participation in the healthcare and dental care benefits offered.
6. Designate beneficiaries for your life benefits in the Beneficiary Designation section. Clearly print their names and relationships to you, and indicate the percentage allocation.
7. Fill in the Dependant Information section, including details about your spouse and any dependants who require coverage.
8. Review the privacy policy section to ensure you understand how your personal information will be handled.
9. Sign and date the Authorizations and Declarations section in ink to affirm your application and consent to the terms.
10. Once all sections are completed, save your changes. You can then download, print, or share the completed form as needed.

Complete your APPLICATION FOR GROUP COVERAGE online to access your benefits without delay.