Follow the steps to successfully complete your enrollment form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal information in the ‘Employee Information’ section. Fill in your last name, first name, middle initial, home address, social security number, city, state, zip code, and telephone number. Make sure all information is accurate and up-to-date.
3. Indicate your gender by selecting either 'Male' or 'Female'. Next, enter your date of birth in the specified format.
4. Answer the question regarding existing vision coverage. If you or your partner is covered by another vision plan, indicate 'Yes' and provide the name of the vision insurer or plan. If not, select 'No'.
5. Complete the 'Dependent Information' section. For each dependent, provide their first name, middle initial, sex (male/female), and date of birth. Ensure you fill in the necessary fields for your spouse and any children you wish to include.
6. Read the section about enrollment conditions carefully. Note that once enrolled, members cannot cancel vision coverage until the open enrollment period or employee termination.
7. Sign the form to verify that the information provided is accurate. Include the date of signing next to your signature.
8. Once completed, ensure all sections are filled out accurately. Save your changes, and then download the form. You may also choose to print or share the form as needed.

Complete your enrollment forms online today for a seamless process.