Get Humana Employee Change Form - Hudson Services Inc

Completing the Humana Employee Change Form provides users with a straightforward method to update their employee benefits and personal information. This guide will help you navigate each section of the form efficiently.

Follow the steps to complete your Humana Employee Change Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by entering your current medical group number and dental group number in the respective fields. Make sure these numbers are accurate, as they relate to your current benefit plans.
3. Next, indicate the proposed effective date for the changes by entering the date in the format DD/MM/YYYY. Ensure this date reflects when you want the changes to take place.
4. Fill in your personal information, including your last name, first name, middle initial, and Social Security number. This ensures proper identification and processing of your changes.
5. Specify the changes you wish to make regarding your medical and dental benefits, including selecting a primary care physician or dentist if applicable. Enter the relevant information in the provided fields.
6. Indicate any changes to life insurance benefits, including basic and voluntary life beneficiaries. Ensure you provide the group number and full names of beneficiaries.
7. If necessary, cancel any coverage by marking the appropriate products, which can include medical, dental, and vision plans.
8. Complete the qualifying event information section by entering the date of the qualifying event and selecting the reason from the provided list.
9. For address changes, indicate whether it applies to yourself or dependents and fill in the new address details.
10. Document any changes to dependents by providing the necessary information for each dependent, including name, Social Security number, and relationship.
11. Finally, sign and date the form if you are requesting changes, and provide the name and relationship of any legal representative if applicable.
12. Once all sections are completed, review the form for accuracy, then save your changes, download the form, print it, or share it as needed.

Complete your documents online for a more efficient process.