Get Hop Administration

This guide provides detailed instructions on completing the Hop Administration form online. Follow these comprehensive steps to ensure a smooth application process for the Health Options Program.

Follow the steps to complete your application effectively.

1. Click the ‘Get Form’ button to access the Hop Administration form and open it for editing.
2. Begin with Section A, where you will indicate the reason for submitting the form by selecting an option such as 'Enroll,' 'Change Option,' or 'Terminate coverage.' Fill in the date of the qualifying event in the specified format (mm/dd/yy).
3. Proceed to Section B, which requires comprehensive details about the retiree's information. Fill in their last name, first name, middle initial, marital status, permanent address, and contact information, including email and phone number.
4. Input the retiree's birth date and retirement date in the required format (mm/dd/yy). Complete the Medicare Information section by providing the Social Security number and claim number along with the effective dates for Parts A and B.
5. If enrolling dependents, fill out the dependent information section by indicating the relationship to the retiree and providing necessary details for each dependent, including their name, address, Medicare information, birth date, and gender.
6. Select the appropriate coverage option in the Option Selection section. Ensure that the selected plan aligns with your Medicare enrollment status. Confirm the start dates for both the retiree and dependents for coverage.
7. Answer the series of questions regarding other medical and prescription drug coverage. Provide details if applicable, particularly if other insurance companies are involved.
8. Review the important information regarding potential extra help, the implications of enrolling, and your responsibility for reporting. Acknowledge your understanding of the terms by signing and dating the application.
9. After completing all sections, ensure that the form is signed where indicated. Save your changes and choose to download, print, or share the completed form as needed.

Complete the Hop Administration form online today to ensure your health coverage needs are met.