Get Allied National - Funding Advantage Employee Enrollment Form 7-1 ...

Filling out the Allied National - Funding Advantage Employee Enrollment Form 7-1 is an essential step for enrolling in your employer's self-funded health plan. This guide will walk you through each section of the form, providing clear and supportive instructions to ensure a seamless online completion process.

Follow the steps to complete your enrollment form accurately.

1. Press the ‘Get Form’ button to acquire the enrollment form and open it in your document editor.
2. Begin with Section 1, where you will enter your full name, marital status, and residence address. Ensure each field is filled out completely and accurately.
3. Fill in the city, state, and telephone number, including the area code. Specify the best time for contact if any additional information is needed.
4. Document the date you began full-time employment and the name of your employer. Include the employer's phone number and location.
5. Provide your occupation and duties along with the average number of hours you work weekly.
6. For health enrollment, check one of the boxes indicating who you are enrolling: self only, self and spouse, self and children, or self, spouse, and children.
7. If you are not enrolling some dependents, specify which ones and the reason why, including a brief explanation if applicable.
8. In participant information, list the names and relationships of individuals to be enrolled, along with their sex, height, weight, date of birth, and social security number.
9. Complete Section 2 regarding prior coverage credit. Indicate whether you or any dependents have had health benefits in the past 90 days. If yes, provide details of the previous health plan.
10. In Section 3, address all medical questions thoroughly. If you answer 'yes' to any question, provide further details as requested.
11. Review and complete Section 4, which includes an employee statement and signature. Confirm that your information is true and complete.
12. Finalize your document by saving changes, and then proceed to download, print, or share the completed form as necessary.

Complete your Allied National enrollment form online today for a smooth insurance process.