Get Illinois Standard Health Employee Application For Small Employers Form

The Illinois Standard Health Employee Application for Small Employers form simplifies the process of applying for health insurance coverage through your employer. This guide provides you with detailed instructions to help you complete the form accurately and efficiently online.

Follow the steps to complete your application successfully.

1. Click the ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Fill out the ‘Employer Information’ section. Provide the employer's name, phone number, and address to ensure proper identification and processing.
3. Indicate the ‘Reason for Enrollment.’ Check all applicable boxes such as New Enrollment or Special Enrollment, and provide dates where required.
4. Complete the ‘Employee Information’ section. This includes the employee's name, job title, marital status, hire date, and contact information.
5. In the ‘Coverage Requested’ section, specify who requires coverage (yourself, spouse, children) and if applicable, make selections for plan choices.
6. If you or any family members are declining coverage, complete the ‘Waiver of Coverage’ section by providing required initials and reasons for declining.
7. List all individuals requesting coverage in the ‘Individuals Requesting Coverage’ section, including their relevant details such as date of birth and primary care physician.
8. Provide ‘Current/Prior Coverage Information’ for each person listed. This includes current coverage status and dates for prior health insurance plans.
9. Complete the ‘Health Statement’ section, answering medically relevant questions truthfully.
10. If you answered 'Yes' to any health questions, provide additional information in the ‘Additional Information’ section.
11. Complete any ‘Additional Coverage Options’ if provided by the employer, like dental or vision.
12. Finally, sign and date the application in the ‘Acknowledgement & Signature’ section, confirming that all information provided is accurate.
13. After filling out all required sections, review your application for accuracy. You can then save changes, download, print, or share the completed form as necessary.

Complete your Illinois Standard Health Employee Application for Small Employers form online today to secure your health coverage.