Get Universal Enrollment Form - Neshaminy

Completing the Universal Enrollment Form - Neshaminy is an essential step for enrolling in coverage. This guide provides you with a clear and structured approach to filling out the form online, ensuring that you submit accurate information.

Follow the steps to complete the Universal Enrollment Form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Review the first section titled 'Subscriber or member enrollment or change.' In this section, you will need to select the type of coverage you are applying for, such as employee only or family.
3. Next, indicate any changes if applicable in the 'Change' section. This may include options like open enrollment or changes to your last name.
4. Move on to the 'Reason for application' section. Select the appropriate reason for your application, such as adding a spouse or changing coverage.
5. In the 'Subscriber information' section, fill out all required fields, including your name, address, Social Security number, and other personal details accurately.
6. If you are applying for coverage for dependents, complete 'Section 4 - Family information.' Provide personal details for each dependent, including birth dates and Social Security numbers.
7. Continue to 'Section 5 - Dependent Information' to answer questions about your dependents' insurance and living situations.
8. In 'Section 6 - Other insurance,' disclose any additional health insurance coverage for yourself or your dependents.
9. The final section, 'Section 7 - Group and employer information,' must be completed by your Group Administrator. Make sure that they provide their signature and any necessary details.
10. After completing all sections, save changes, download the form for your records, and print it if needed. Ensure to mail the application according to the provided instructions.

Begin filling out your Universal Enrollment Form - Neshaminy online today to secure your coverage.