Get Hbpapplication2012.indd. Image - Hr Hunter Cuny

Filling out the Hbpapplication2012 form is a straightforward process that requires careful attention to detail. This guide will walk you through each section of the form to ensure you provide all necessary information accurately and completely.

Follow the steps to complete your health benefits application effectively.

1. Click the ‘Get Form’ button to retrieve the document and open it in your preferred editing software.
2. Select your status as either EMPLOYEE or RETIREE by checking the appropriate box at the top of the form.
3. In Section A, indicate the reason for submission by checking one or more boxes that apply to your situation. Remember to enter the change date if applicable.
4. For Section D, fill in your personal information including last name, first name, middle initial, home address, Social Security number, date of birth, marital status, and sex.
5. Complete Section E with your spouse or domestic partner information, including whether they are employed or retired, and if they will be covered under your plan.
6. List all eligible dependents in Section F, entering their names, birth dates, Social Security numbers, and indicating if they are full-time students or permanently disabled.
7. In Section G, write the name of the health plan you are requesting and indicate if you want optional benefits.
8. Sign and date the form in Section H to certify that all information is accurate, or complete Section I for the Health Benefits Buy-Out Waiver Program if applicable.
9. If required, Section J must be completed by your payroll or personnel office to verify your eligibility.
10. Once the form is completed, you can save your changes, download a copy, print it out, or share it as needed.

Complete your health benefits application online today to ensure you have the coverage you need.