Get Employee Enrollment Form - O.c.a. Benefit Services

Filling out the Employee Enrollment Form for O.C.A. Benefit Services online is an essential step in managing your benefits. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click 'Get Form' button to obtain the Employee Enrollment Form and open it in the editor.
2. Complete the 'Company Name' field, as this is required for processing your application.
3. In the 'Type of Activity' section, select the applicable option and fill in the appropriate dates.
4. Fill out the 'Employee Information' section, ensuring all fields are completed, including your first name, last name, mailing address, and date of birth.
5. In the 'Reporting Elected/Terminated Coverage' section, check off the applicable categories, noting any contributions as required.
6. Complete the 'Covered Dependent Information' for each family member you wish to include, filling in their details accurately.
7. If applicable, sign the 'Release of Protected HIPAA Information' section to authorize communication regarding your coverage.
8. Sign the 'Employee Enrollment Authorization' section, confirming the accuracy of the information provided.
9. Ensure the 'HR or Plan Administrator' section is signed by an authorized individual for processing your application.
10. If you choose to, complete the optional 'mySource Card Enrollment Agreement' and/or 'Employee Direct Deposit Authorization.'
11. Once all sections are completed and verified, save your changes, download the form, and print or share it as needed.

Complete your employee enrollment form online today to ensure your benefits are properly managed.