Get 1199 Members Choice Enrollment

Filling out the 1199 Members Choice Enrollment form online is a straightforward process that allows you to select your preferred healthcare options with ease. This guide aims to help you navigate each step of the form, ensuring that you provide accurate information for a successful enrollment.

Follow the steps to complete the enrollment form

1. Press the ‘Get Form’ button to obtain the enrollment form and open it in your chosen editing tool.
2. Mark the appropriate box to indicate whether you are enrolling for the first time, changing hospitals, or changing primary care doctors.
3. Enter your Member ID or Social Security number along with your full name clearly.
4. Fill in your address, city, state, and zip code, ensuring that all information is accurate.
5. Provide your telephone number and date of birth in the specified format.
6. Select your sex by marking the relevant option.
7. List your employer's name and date of hire.
8. Indicate your current marital status by selecting one of the options provided.
9. Clearly print your choice of Member Choice Hospital and Primary Care Doctor next to your name, as well as the names and dates of birth of each eligible family member.
10. Answer the question regarding whether your spouse or dependent children have other health insurance coverage.
11. If applicable, complete the section that asks for the name of the insurance company, policyholder, group number, and type of coverage.
12. Review the declaration statement regarding your request to participate in the 1199SEIU Benefit Funds Member Choice Program, then provide your signature along with the date.
13. Finally, save your changes and utilize options to download, print, or share the completed form.

Take the next step and complete your 1199 Members Choice Enrollment online today!