Get Group Membership Change Form - Kirkwood

This guide provides step-by-step instructions for filling out the Group Membership Change Form - Kirkwood online. Whether you are making changes to your personal information or adding dependents, this guide will support you in completing the process accurately.

Follow the steps to successfully complete your Group Membership Change Form.

1. Press the ‘Get Form’ button to access the Group Membership Change Form, opening it in your preferred online editor.
2. Begin by entering the group name and contact information. Ensure that the details are accurate, as they are essential for processing your request.
3. Next, fill in the group number and phone number. Be sure to provide a complete employee name, including both first and last names, as well as the employee ID number.
4. If you are making an address change, complete the old street address and city fields, followed by the new street address, city, state, and zip code.
5. For name changes, indicate the current name on the membership records and the new name you wish to have updated.
6. If cancelling coverage, provide details about the event, including the date of the event and the intended cancel date. Select the type of coverage being canceled.
7. When adding dependents, provide the necessary information for each dependent, including their name, date of birth, and other relevant details. Make sure to specify the reason for addition.
8. For other carrier information, indicate if you or any covered individuals are maintaining additional health coverage. Complete the required details if applicable.
9. After completing all sections of the form, review the information for completeness and accuracy.
10. Finally, sign and date the form to certify the accuracy of the information provided, then save the changes, download, print, or share the completed form as needed.

Take action today and complete your Group Membership Change Form online.