Get Da Form 5137

Filling out the Da Form 5137 online can streamline the process of managing your retiree coverage. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently, ensuring that all necessary information is provided.

Follow the steps to fill out the form with ease.

1. Click ‘Get Form’ button to obtain the document and access it in the designated editor for online completion.
2. Begin with Section 1: Subscriber Information. Fill in your Social Security number, name, address, and other personal details clearly. Make sure to provide your date of birth and contact information.
3. Proceed to Section 2: Spouse or State-Registered Domestic Partner Information. If applicable, list your partner’s details including their Social Security number and date of birth. Indicate whether you want to cover or remove them from the plan.
4. Next, head to Section 3: Family Member Information. Enter details for any eligible family members you wish to cover. Ensure all required eligibility certifications are attached if necessary.
5. Review Section 4: Changes to an Existing Account if you are modifying your coverage. Indicate the changes you wish to make and the corresponding events that prompted these changes.
6. In Section 5: Medical Plan Selection, select the medical plan that meets your needs. Contact information for each plan is provided for additional queries.
7. Then, navigate to Section 6: Dental Plan Selection. Check the box corresponding to your choice of dental coverage, noting that you must enroll in medical coverage to have dental.
8. Fill out Section 7: Term Life Insurance Enrollment Information if you are interested in enrolling in this insurance. Provide the beneficiary’s details as requested.
9. In Section 8: Payment Authorization, choose your preferred payment method for premiums. Be sure to understand the implications of your choice.
10. Finally, review Section 9: Signature. Sign and date the form to confirm that all information is accurate. Once all sections are complete, you can save changes, download the form, print it, or share it as needed.

Complete your forms online today and ensure your retiree coverage is up to date!