Get Employee Eligibility Statement Add On - Starmark

The Employee Eligibility Statement Add On - Starmark is a crucial document for employees to enroll in their employer's health coverage. This guide provides clear step-by-step instructions on how to complete the form online, ensuring that users can accurately submit their information.

Follow the steps to successfully fill out the Employee Eligibility Statement Add On - Starmark.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling out the employer information section. Enter the company name, location (state and ZIP), plan choice (if available), and group number if applicable.
3. Move on to the employee information section. Complete all fields including legal first name, middle initial, legal last name, address, city, state, ZIP, email address, and social security number. Ensure that you indicate your sex and marital status as well as your annual salary.
4. In the beneficiary information section, list the beneficiary's name, address, and relationship to you for coverage purposes.
5. Navigate to the coverage information section. Indicate whether you are applying for coverage or declining it. Check the appropriate boxes for the type of coverage you are requesting, such as employee only, employee and spouse/domestic partner, or employee and children.
6. If applicable, provide reasons for enrollment or for declining coverage, selecting from the available options provided.
7. Fill out the special enrollee section if relevant, indicating loss of coverage or any life-changing events that may apply to your situation.
8. Complete the dependent information section by providing details for each dependent being covered, including their legal names, birth dates, social security numbers, and sexes.
9. In the other coverage section, indicate whether you or any dependents have existing major medical coverage and provide details if applicable.
10. Review all the information you have entered, ensuring it is accurate and complete.
11. Sign and date the agreement and authorization section before submitting. Make sure to opt-in for the Starmark Document Center, if you wish, by checking the appropriate box.
12. Once completed, you can save changes, download, print, or share the form as needed.

Complete your Employee Eligibility Statement Add On - Starmark online today to ensure your health coverage.