Get Group Insurance Change Request Form - Rak Agency Inc

Filling out the Group Insurance Change Request Form is an essential step in managing your insurance needs. This guide is designed to provide clear and supportive instructions for completing the form online, ensuring you can submit your changes accurately and efficiently.

Follow the steps to complete your insurance change request online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the employer's name and the policy number, listing all affected policy numbers where prompted.
3. Provide the group ID, insured’s name, and social security number in the designated fields.
4. If there are name or address changes, clearly indicate the previous and new information in the Name/Address Change section.
5. Complete the Beneficiary Change section, specifying the primary and contingent beneficiaries along with their relationships.
6. For dependents being added or removed, indicate your choice and fill out the relevant details, including names, dates of birth, and relationships.
7. In the Changes in Coverage section, provide the effective dates and the respective changes in coverage amounts for employee and spouse coverage as needed.
8. If requesting any replacements or additional information, check the appropriate boxes and provide the necessary details in the sections provided.
9. Once all fields are completed, review the form for accuracy, then save the changes. You can download, print, or share the completed form as necessary.

Take control of your insurance changes by completing your Group Insurance Change Request Form online today.