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Get Enrollment/change Form-vision - Pcms
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How to fill out the Enrollment/Change Form-VISION - PCMS online
Completing the Enrollment/Change Form-VISION - PCMS online is a straightforward process that ensures you receive the necessary vision coverage. This guide provides step-by-step instructions to help you accurately fill out the required sections of the form.
Follow the steps to complete the form online easily.
- Click ‘Get Form’ button to access the Enrollment/Change Form-VISION - PCMS and open it in your document editor.
- Review the first section titled 'Action'. Here, you need to select your action: whether you are submitting a new application for coverage, changing authorization, or waiving coverage. Fill in the appropriate fields based on your needs.
- In 'Employee Information', provide your Social Security or ID Number, Group Number, and Employer/Group Name, ensuring that you do not abbreviate any entries. Also, fill in your home address, hire date, birth date, and select your marital status.
- Select the type of vision coverage you are applying for — Single or Family. Make sure to list dependent information in the designated area. For any family members to be included, fill their full names, genders, birth dates, and any other required details.
- Proceed to Section 3, where you must sign and date the authorization. This indicates your acceptance of the group vision coverage and your agreement to the necessary deductions from your earnings.
- If applicable, complete Section 4, titled 'Waiver of Coverage'. Here you need to certify your decision regarding the vision coverage for yourself and any dependents, stating reasons if you are choosing to waive coverage.
- Finally, in Section 5, mark any changes you wish to report such as marriage, divorce, or any adoption/custody events, ensuring you notify Surency of any changes within the stipulated timeframe.
- After completing the form, you can save your changes, download the document for your records, print a copy, or share it as necessary.
Complete your Enrollment/Change Form-VISION - PCMS online today to ensure your vision coverage needs are met.
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