Get 1-50 Small Group Information Change Form - Lisi

This guide provides clear instructions on how to complete the 1-50 Small Group Information Change Form - LISI online. By following these steps, you will ensure that your form is accurately filled out and submitted.

Follow the steps to successfully complete your form.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Fill in the group name and group number at the top of the form. Make sure these details are accurate.
3. Indicate the purpose of the form by selecting the appropriate options for terminating employees or making address changes.
4. In Section 1, provide details for each terminating employee. This includes the employee's name, social security number or ID number, date of birth, and termination date.
5. Decide if you need to offer COBRA or Cal-COBRA and respond accordingly by checking 'Yes' or 'No' where applicable.
6. For dependents, repeat step 4, filling out their names, social security numbers or ID numbers, and select coverage types being deleted.
7. In Section 2, fill out the employee or group change of address as necessary, providing the new street address, city, state, and ZIP code.
8. Review all information provided to ensure accuracy and completeness before finalizing.
9. Once all sections are completed, choose to save your changes, download, print, or share the form as needed.

Complete your documents online with confidence and ensure timely submission.