Get Member Enrollment Form - Uha

Filling out the MEMBER ENROLLMENT FORM - UHA is an essential step for users seeking to enroll in health coverage. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently online.

Follow the steps to successfully complete the form online:

1. Click ‘Get Form’ button to access the MEMBER ENROLLMENT FORM - UHA in your preferred editing platform. This action will enable you to begin completing the necessary fields.
2. In the 'Reason for Enrollment' section, select only one option that best describes your purpose for completing the form. Options include open enrollment, adding a new subscriber, reinstating a subscriber, or adding dependents.
3. Fill in the 'Group Information' section with the required details. Enter the group name and the group/division number. Make sure the information entered matches your organization’s records.
4. Proceed to the 'Benefit Information' section. Select your plan type, and indicate the effective date for your coverage, which is generally the first day of the month when your benefits will begin.
5. In the 'Subscriber Information' section, carefully provide all required details such as your social security number, birth date, and contact information. Ensure accuracy in your name, address, and any other fields requested.
6. If applicable, complete the 'Add Spouse or Civil Union Partner Information' section. This step involves providing details about your spouse, civil union partner, or dependents if adding outside of open enrollment.
7. If you have dependents to enroll, fill out the 'Dependent Information' section with all necessary data for each dependent. If additional rows are needed, be sure to attach another sheet.
8. Review the 'Required Signatures' section. The subscriber must sign and date the form, and a group administrator must also sign and date it to validate the enrollment.
9. Once all sections are completed, save your changes. You may then download, print, or share the completed form as needed. Make sure to include any required supporting documents before submitting.

Begin filling out your MEMBER ENROLLMENT FORM - UHA online today to ensure timely enrollment.