Get Bcbs 16628 Enrollment Form - People Lease

Completing the BCBS 16628 Enrollment Form - People Lease online is a straightforward process. This guide provides you with detailed, user-friendly instructions to successfully fill out each section of the form.

Follow the steps to complete your enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the Group Number and Enrollment type. You need to indicate the effective date and check the appropriate boxes for New Hire, Open Enrollment, Qualifying Event, or Retired status.
3. In the Employee section, provide your full name, Social Security number, marital status, and birth date. Be sure to print all information clearly.
4. Complete your mailing/street address, including city, state, and zip code. Specify your occupation and hire date.
5. Indicate if you have prior medical coverage by checking 'Yes' or 'No.' If 'Yes', enter the coverage dates.
6. Select your desired medical and dental coverage types by choosing one of the options: Employee, Family, Employee + Children, or Employee + Spouse.
7. If you have other insurance, indicate 'Yes' or 'No' and complete the 'Other Coverage' form if necessary.
8. Fill out the dependents section by listing all individuals to be covered under your plan, including name, relationship, sex, date of birth, and Social Security number.
9. Read the certification statement carefully. You will need to confirm that all information provided is complete and accurate before signing.
10. Finally, sign and date the form in the authorization section. Ensure that all required information is complete before submitting.

Complete your documents online today to ensure seamless enrollment in your health insurance coverage.