Get Georgia Region Group Enrollment/ Change Form For Large Group

Filling out the Georgia Region Group Enrollment/Change Form for Large Group online is a straightforward process. This guide will walk you through each section of the form, ensuring you understand how to accurately provide the necessary information for your enrollment or changes.

Follow the steps to complete your enrollment change form online

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin with the 'Company name' field at the top of the form. Enter the legal name of your company.
3. Next, fill in the 'Group number' and 'Subgroup number' fields, ensuring you have the correct numbers assigned by the insurance provider.
4. Include the 'Date of hire' in the specified format (mm/dd/yyyy) for the employee enrolling.
5. Specify the 'Effective date' of the enrollment using the required format (MM/DD/YYYY). Ensure this date aligns with your company's benefits schedule.
6. Select the appropriate enrollment reason by checking one of the boxes for 'New group', 'Open enrollment', 'New hire', 'Cobra', 'Loss of other coverage', or 'Other'.
7. If applicable, indicate the 'Date of event' that necessitates the enrollment or change.
8. If cancelling all coverage, check the appropriate box and complete section A.
9. For changes, such as adding or deleting dependents, follow the instructions for completing sections A, B, E, and G as provided in the form.
10. Complete 'A. Employee information' by providing your last name, social security number, first name, medical record number (if any), and date of birth.
11. In section B, provide family information, detailing any dependents that are being added or removed, along with their relevant information.
12. Proceed to section E to disclose any other coverage information, if applicable.
13. If waiving any coverage, complete section F by selecting the reasons for refusal and providing necessary details.
14. At the end of the form, make sure to read the important notes and sign where indicated to ensure your application can be processed.
15. Finally, save changes, and download or print the form as needed to submit it to your company's Benefits Administrator.

Start filling out your Georgia Region Group Enrollment/Change Form online today!