Get Eyemed Enrollment Form - Pcms

Filling out the EyeMed Enrollment Form - PCMS online can be a straightforward process when approached step by step. This guide will help you navigate each section of the form to ensure your information is clearly and accurately submitted.

Follow the steps to complete your EyeMed Enrollment Form - PCMS online.

1. Click ‘Get Form’ button to obtain the EyeMed Enrollment Form - PCMS and open it for editing.
2. Begin by filling out the employer information section. Enter the employer name and group number provided by EyeMed, as well as the optional location code, if applicable. Specify the effective date as set by your employer.
3. Proceed to the employee information section. Indicate whether you are adding, terminating, or changing information by selecting the appropriate checkbox. Fill out your personal details, including name, date of birth, sex, Social Security number, and home address.
4. In the family information section, list only the eligible family members who you wish to add. For each dependent, indicate their relationship to you and select the appropriate action (Add, Terminate, Change). Provide personal details as required, including name, date of birth, and Social Security number.
5. Once all fields are filled out, review the information for accuracy. Ensure each section is completed with the necessary details about yourself and your eligible dependents.
6. Finally, sign and date the form at the bottom. This confirms the accuracy of the information provided and your consent to enroll in EyeMed coverage.
7. After completing the form, you can save changes, download a copy for your records, print it for submission, or share it with necessary parties.

Take the first step towards your EyeMed coverage by filling out your enrollment form online today.