Get Ameritas Dental/vision Change Form

This guide provides step-by-step instructions for completing the Ameritas Dental/Vision Change Form online. It is designed to help users navigate the process smoothly and efficiently, ensuring all necessary information is accurately provided.

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. Begin by filling out the employee information section. Provide your last name, first name, middle initial, date of birth, and social security number. Indicate your marital status (single or married) and whether you are a full-time or rehire employee.
3. Complete the mailing address information including street address, city, state, and zip code. Ensure that this information is current to avoid any communication issues.
4. Indicate whether you are covered under another dental or eye care insurance plan for both yourself and dependents by checking the appropriate boxes.
5. Provide the dependent coverage information. List all eligible dependents you wish to add or drop, including their full legal names, relationship to you, sex, date of birth, and social security numbers.
6. Review the certification and signature sections. Sign and date the form to confirm the accuracy of the information provided and your agreement to the terms outlined.
7. Once you have completed all sections, review the form for any missing or incomplete information to prevent delays. After verifying everything is correct, you can save changes, download, print, or share the form as needed.

Complete your documents online today and ensure your dental and vision coverage is up-to-date.