Get Group Marketplace Subscriber Application - Kluge Insurance Group

Filling out the Group Marketplace Subscriber Application is an important step in obtaining health coverage through the Kluge Insurance Group. This guide offers clear instructions on completing the application form online, ensuring that you provide all required information accurately.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering general administrative information for the employer, including the group number, insurance ID number, segment/division, effective date of change, group employee ID number, and annual salary.
3. Select your desired marketplace plan from the available options and enter the marketplace plan number.
4. Indicate the reason for submitting the application by selecting one of the checkboxes provided, such as group initial enrollment or employee new hire.
5. Provide information for the applicant (employee), including name, primary care physician details, contact information, job description, employment status, date of hire, and tobacco use status.
6. Fill out the dependent information section, listing each dependent's legal name, relationship, date of birth, social security number, and tobacco use status.
7. Review the declarations section carefully, ensuring you understand the conditions of coverage and sign the form electronically, providing the date signed.
8. Once all sections are filled out accurately, save the changes, and prepare to download, print, or share the completed form as needed.

Complete your documents online today to secure your health coverage.