Get Bcbsri Member Waiver Form

Filling out the BCBSRI Member Waiver Form online is a straightforward process that allows members to opt out of certain insurance coverages. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the BCBSRI Member Waiver Form online.

1. Click ‘Get Form’ button to obtain the form and launch it in your editing environment.
2. Input the employer's name and group ID number in the designated fields. These details are crucial for identifying the correct insurance plan.
3. Enter your name as the employee in the specified area. Ensure that you fill in your full legal name for accurate record-keeping.
4. Provide the date on which you are filling out the form. This date is important for processing your waiver correctly.
5. If applicable, list the name(s) of your spouse and/or children. For children, include details for those under age 19, or aged 19 to 25 who are full-time students and financially dependent on you.
6. Select the type of waiver you are applying for. Indicate if the waiver is for health coverage, dental coverage, or both. Check all options that apply.
7. In the section titled 'Reason for Waiver', specify the reason you are opting out of the coverage. List the applicable person's first name under the relevant category.
8. Read and understand the implications of your waiver selection. This includes noting any penalties for opting out and conditions for later enrollment.
9. Complete either the 'Waiver By Employee' or 'Certification Of Employer' section, depending on your role. Sign and date the appropriate field.
10. Once all fields are filled out accurately, you may save changes, download, print, or share the completed form as needed.

Begin filing your BCBSRI Member Waiver Form online today and ensure your insurance needs are met.