Get Assurant Time Ins Self Funded - Easyappsonline

Completing the Assurant Time Ins Self Funded employee enrollment form online is a straightforward process that facilitates your participation in the coverage options provided by your employer. This guide offers step-by-step instructions to ensure you accurately fill out each section of the form.

Follow the steps to complete your enrollment form successfully.

1. Click the ‘Get Form’ button to obtain the enrollment form and open it in your preferred online document editor.
2. Entrust critical information by entering your employer's name and work address. This section verifies your eligibility and aids in identifying your employer’s specific plan offerings.
3. Provide your personal information in Section A, including your name, mailing address, contact numbers, email address, citizenship status, employment date, marital status, and occupation. Ensure accuracy, as this information is essential for your insurance coverage.
4. If applicable, complete Section B for modifications to existing coverage or if you are a new hire. Specify the group number and effective date, and select the necessary options regarding the type of enrollment.
5. In Section C, identify all individuals to be covered under the plan, including their relationship to you. Complete the table with full names, genders, dates of birth, and social security numbers.
6. Section D requires detailed information about any additional insurance coverage you and your dependents may have. Answer how existing plans will interact with the new coverage.
7. If you choose to waive coverage, fill out Section E, stating the reason for your decision. Sign and date the waiver to complete this section.
8. Section F gathers your medical history. Answer the questions accurately about past treatments and conditions for yourself and dependents to assess eligibility.
9. Detail any affirmative answers from Section F in Section G, providing explanation and context as needed.
10. Review and sign Section H to authorize the enrollment and confirm the accuracy of your provided information. Ensure you understand the implications of your enrollment.
11. Upon completion, save your changes. You can then download, print, or share the form as necessary for your records or submission.

Start filling out your Assurant Time Ins Self Funded enrollment form online today!