Get Encon Enrollment Form

Filling out the Encon Enrollment Form online is a straightforward process that helps ensure you receive the appropriate benefits. This guide will walk you through each section of the form, providing detailed instructions to help you complete it successfully.

Follow the steps to complete the Encon Enrollment Form online

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin by filling in the employee information section. Clearly print your name, employer's name, client number, and employer's address. Include your own name, social insurance number or certificate number, your address, date of birth, and date of employment.
3. In the next section, indicate your gender and employment status by selecting either male or female and whether you are full-time or part-time. Then, choose the coverage options for health and dental benefits as applicable.
4. Provide details of annual earnings and state whether you are requesting to coordinate or waive benefits for health and dental coverage.
5. For dependent information, include the names and dates of birth for each dependent and specify their relationship to you. Indicate relevant details about your spouse's insurance provider and policy number.
6. Complete the change request section if applicable by selecting the nature of the change, such as termination, layoff, or status change, and specify whether it pertains to single or family status.
7. In the occupation section, provide your job title or position.
8. Fill out the beneficiary designation section, including the full name, relationship, and percentage of benefit assigned for each beneficiary. If a beneficiary is a minor, consider assigning a trustee.
9. The last sections require you to authorize the application by signing and dating the form, confirming your understanding of the terms and conditions.
10. Before finalizing, review all the filled sections for accuracy. Once satisfied, save your changes and then either download, print, or share the form as needed.

Complete your Encon Enrollment Form online today to ensure you receive your benefits promptly.