Get Dane County Health Plan Application ... - Wea Trust

Filling out the DANE County Health Plan Application is an essential step for individuals seeking health coverage through the WEA Trust. This guide provides clear instructions to ensure that you complete the application accurately and efficiently.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering your personal information, including your employee name (last, first, middle), department, mailing address, home phone, city, state, zip code, and county.
3. Indicate your marital status by selecting one option: single, married, or divorced. If applicable, provide your maiden name.
4. Specify your employment details, including your date of hire, full-time or part-time status, work phone, whether you are actively at work, and the number of hours worked per week.
5. List all family members for whom you are applying for coverage by providing their name (last, first, middle), gender, social security number, relationship to you, and date of birth. Indicate if any family member is disabled.
6. Complete Section A if you need to transfer or change coverage or during the annual choice period. Specify the type of change and any new enrollment information required.
7. If you or any family member has other group health insurance, complete the section for Other Coverage, providing the name of the present group health insurance, group number, and subscriber details.
8. If anyone listed is covered by Medicare, fill out Section C with the necessary Medicare details, including effective dates and subscriber Medicare number.
9. Read and agree to the acceptance of insurance terms at the end of the application. Choose to sign electronically by checking the 'I Agree' box or provide a paper signature. Also, indicate if you choose to waive coverage.
10. Finally, review your application for completeness, save your changes, and download, print, or share the application as needed.

Ensure your health coverage by completing the DANE County Health Plan Application online today.