Get Gfnbc

Filling out the Gfnbc form electronically is a straightforward process designed to facilitate employee change requests. This guide will walk you through each section of the form step-by-step to ensure you provide the necessary information accurately.

Follow the steps to complete the Gfnbc form online.

1. Click 'Get Form' button to obtain the Gfnbc form and open it for completion.
2. Section A: General Information. Enter the employer name and group number. Fill in the employee's last and first names.
3. Section B: Employee Information – this section is required. Indicate the reason for the change by checking all applicable boxes, such as address change, adding a dependent, or name change.
4. Provide the event reason by checking all that apply, including options like marriage or birth of a child. Fill in the event date/requested effective date, home address, and the employee's birthdate.
5. Complete additional personal information including employee ID/Social Security number, Medicare enrollment status, marital status, primary and secondary phone numbers, email address, and primary care physician details.
6. Section C: Family Information. Specify if you need to add, change, or cancel coverage for a spouse or dependents. Complete the required fields for each individual.
7. Section E: Other Group Coverage. Answer questions regarding eligibility for Medicare or coverage under other health plans, providing necessary identifiers.
8. In Section F: Terms, Conditions and Authorizations, read the disclaimer and sign the form electronically, affirming that all provided information is true and complete.
9. Review all sections for accuracy. Once complete, you will have the option to save changes, download a copy, print it, or share the form as needed.

Complete your forms online today to ensure timely processing of your employee change requests.