Get Employee Status Change Form - Avmed - Avmed

Completing the Employee Status Change Form is an essential process for users wishing to update their employment status or personal information with AvMed. This guide will provide you with clear and concise instructions to ensure your form is filled out accurately and submitted effectively.

Follow the steps to fill out the Employee Status Change Form online.

1. Click the ‘Get Form’ button to access the Employee Status Change Form. This action will allow you to open the document for editing.
2. Provide your employer's name and group or division number in the first section labeled 'Employer & Employee Information.' Be sure to have your AvMed ID ready as you will also need to fill out your name here.
3. In the 'Employee Information Change' section, check off the relevant boxes to indicate the type of change you are making, such as a name change or address change. Fill in the corresponding details such as your last name, first name, street address, and any additional information required.
4. Next, update your contact information by entering your home phone, cell phone, work phone, email address, and your current city, state, and zip code.
5. If you are adding dependents, indicate the type of event (e.g., marriage, adoption) and fill out the related sections with the dependent’s name, birth date, and any other requested information, referring to the legend included for clarity.
6. If you are disenrolling anyone from coverage, specify the action required and provide their information, including effective date and reason for disenrollment.
7. Review the certification and authorization statement to ensure you understand your rights and responsibilities. You must sign and date this section to validate your request.
8. Finally, check all entries for accuracy. You can then save your changes, download the completed form, print it, or share it as necessary.

Start filling out the Employee Status Change Form online today to ensure your information is up to date.