Get Standard Employee Application Form

Filling out the Standard Employee Application Form online is a straightforward process designed to gather essential information for your health insurance application. This guide will lead you through each section of the form, ensuring that you provide accurate and complete information to facilitate your enrollment.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the application and open it in the designated editor.
2. Review the employer information provided at the top of the form, including the employer name, phone number, and address.
3. Indicate the reason for enrollment by selecting all applicable options such as new enrollment, special enrollment, or dependent addition.
4. Fill in your personal information including your name, job title, marital status, and contact details.
5. In the coverage requested section, specify whether you need medical coverage for yourself, spouse/domestic partner, and children, and indicate your plan choices.
6. If you are waiving coverage, complete the corresponding section by selecting the applicable options that indicate for whom you are declining coverage.
7. List all individuals requesting coverage, ensuring to provide necessary details like dates of birth, social security numbers, and primary care physicians.
8. Provide current or prior coverage information for each individual, along with the policyholder's name and insurer name.
9. Answer the health statement questions, ensuring to respond truthfully and thoroughly, as this section is key for coverage evaluation.
10. If applicable, complete the additional information section for any medical conditions answered with 'Yes' in the previous section.
11. Review the acknowledgment and signature section for consent, ensuring understanding of the terms. Provide your electronic signature where required.
12. Once all information is filled out, save your changes, and proceed to download, print, or share the completed form as needed.

Complete your application today to ensure your health coverage is in place!