Get Member Change Form - Summacare

Filling out the Member Change Form for SummaCare is a straightforward process that ensures your details are up to date. This guide will provide you with step-by-step instructions to help you navigate and complete the form efficiently.

Follow the steps to accurately complete your Member Change Form.

1. Press the ‘Get Form’ button to access the Member Change Form and open it in your preferred editor.
2. Begin by completing the employer section at the top of the form. This information includes the date received by the employer, employee class (hourly or salary), and group number.
3. Move to the employee section and fill in your name as it appears on the original application. Provide your division number and indicate if you are a retiree.
4. In the employee information change section, select the applicable boxes for the changes you are making, such as address, marital status, or name change, and provide detailed information in the fields provided.
5. If adding or updating family members, navigate to the member changes section. Complete the requested fields, including names, social security numbers, relationship to employee, dates of birth, and relevant reason codes for the changes.
6. Fill in any additional health insurance coverage information if applicable. Indicate whether you or your dependents are currently covered by other health insurance.
7. Carefully review the terms and conditions section and ensure your understanding and agreement by signing and dating the form.
8. After completing all sections, you can save changes, download the form, print it, or share it as necessary before sending it back to your benefits office.

Complete your Member Change Form online today to ensure your information is current and accurate.