Get Concordiaplans

Filling out the Concordiaplans form online is a straightforward process that ensures your enrollment in the necessary Concordia Plans. This guide provides step-by-step instructions for each section of the form, tailored to meet the needs of all users.

Follow the steps to complete your Concordiaplans form online.

1. Click ‘Get Form’ button to obtain the Concordiaplans document and open it in the editor.
2. Begin by filling out the 'Employer Information' section. Enter your employer's name, employer ID number, address, city, state, zip code, and contact details as prompted in the form.
3. Proceed to complete the 'Worker Information' section. Fill in your name, previous last name, social security number, date of birth, gender, and address. Ensure that all personal information is accurate.
4. If applicable, complete the 'Spouse Information' section by providing details of your spouse's name, date of birth, and social security number.
5. In the 'Child(ren) Information' section, list any eligible children for coverage. Ensure you check the requirements for each child's eligibility under the different plans.
6. Review the 'Concordia Health Plan Enrollment' section where you will check your desired coverage options and indicate whether you wish to enroll yourself and any eligible dependents.
7. Fill out the 'Reason For Non-Enrollment' section if you are declining to enroll. Provide specific reasons for this choice as detailed in the form.
8. Complete sections regarding insurance programs, acknowledging any special enrollment situations if applicable.
9. Finally, review all your entries for accuracy, then sign the form in the designated areas for both the worker and the employer representative.
10. Save your changes, then download, print, or share the completed form as necessary.

Complete your Concordiaplans enrollment online to ensure you receive the benefits you need.