Get Maurices Application

The Maurices Application is an essential document for those seeking coverage under a group health insurance plan. Filling out this application accurately ensures you receive the appropriate benefits. This guide provides detailed instructions to help users fill out the application online with ease.

Follow the steps to complete your application seamlessly.

1. Click ‘Get Form’ button to obtain the application and open it for filling out.
2. In the employer information section, enter the employer’s name, group number, and division number. Specify the employee class and state the total number of permanent employees who work 30 or more hours a week.
3. Proceed to the employee information section. It is crucial to accurately provide personal details such as your first name, middle initial, last name, social security number, date of birth, sex, height, and weight. Ensure to fill in your complete address along with your phone numbers and email.
4. Answer the employment-related questions, including the start date of your employment and the average hours worked weekly. Indicate your marital status and provide any relevant details in the appropriate fields.
5. In the type of health coverage section, select the option that best describes your desired insurance coverage: employee only, employee and spouse, employee and dependent child(ren), or employee, spouse, and dependent child(ren).
6. In the dependent information section, list all dependents applying for insurance coverage. This includes their names, social security numbers, birth dates, height, weight, and relationships to you. Ensure this section is thoroughly completed.
7. Continue to the medical information section. Answer the provided questions to the best of your knowledge regarding current health status, previous medical conditions, and treatments. Provide additional details if any ‘Yes’ responses are given.
8. If applicable, fill out the waiver of coverage section, stating if you or your dependents are waiving insurance coverage and the reasons for doing so.
9. Complete the current and previous coverage section, detailing any other health insurance coverage that you, your spouse, or dependent children currently have or have had in the last 18 months.
10. Sign and date the application at the designated areas, ensuring all necessary parties have also signed where required. This includes the authorization to use and disclose protected health information if applicable.
11. Finally, review the entire application for accuracy. Save your changes, and you can then download, print, or share the completed application.

Complete your Maurices Application online today to ensure you receive the insurance coverage you need.