Get Nea Insurance Operations Non Smoker Form

Filling out the Nea Insurance Operations Non Smoker Form online is a straightforward process. This guide provides comprehensive instructions to help you navigate each section of the form, ensuring that all required information is submitted accurately.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Locate the certificate number field and enter your certificate number, as indicated in your last premium notice.
3. In the 'Plan Name' section, fill in the name of your insurance plan.
4. Provide the member’s name by filling out the 'FIRST,' 'MI,' and 'LAST' fields.
5. If requesting for a spouse, enter their name in the designated fields (FIRST, MI, LAST).
6. Complete the address section, including your city, state, and zip code.
7. Input your daytime phone number in the specified format: (____) - ____ - ______.
8. Respond to the smoking status question, indicating whether you or your spouse have used tobacco or nicotine in the past 24 months.
9. Ensure both the member and spouse sign the declaration area, confirming the information is accurate, and provide the date signed in the requested format.
10. Once all fields are completed, save your changes, and consider downloading, printing, or sharing the completed form as necessary.

Complete your Nea Insurance Non Smoker Form online today to request your non-smoker rates.