Get Geisinger Form Mc 32 26

Filling out the Geisinger Form Mc 32 26 online is a straightforward process that allows you to update your subscriber information efficiently. This guide will walk you through each section of the form, providing detailed instructions to ensure you complete it accurately.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin with Section I, where you will enter your subscriber information. Input your group number, division number, insurance I.D. number, legal name (last, first, middle initial), and contact address details including city, state, zip code, and county. Make sure your social security number is also included.
3. Move to Section II, which outlines any changes you would like to make. Check the box next to each applicable change, such as adding or removing dependents, changing your address, or altering your primary care physician. If changing your primary care physician, indicate the reason from the provided options.
4. In Section III, check the reason for disenrollment if applicable. Options include dissatisfaction with the plan, layoff, or loss of dependent status. Fill out the necessary date fields as required.
5. For Section IV, determine whether the changes noted are due to a Qualifying Event under COBRA or Mini-COBRA. Check the appropriate box for yes, no, determination pending, or not applicable.
6. Proceed to Section V, where you will provide details for any subscriber and dependent changes. Fill these details accurately, ensuring you note names, birthdates, social security numbers, and changes of status.
7. Lastly, review the statement regarding the application for amendment and sign where indicated, including the date signed. If applicable, a group benefits administrator must also sign and date the form.
8. Once all sections are complete, make sure to save your changes. You can download, print, or share the filled form as required.

Complete your Geisinger Form Mc 32 26 online today!