Get Ume Health Plan Enrollment Form

Completing the UME Health Plan Enrollment Form online is a straightforward process designed to facilitate your enrollment in health coverage. This guide will walk you through each section of the form, ensuring you provide accurate and complete information to secure your coverage.

Follow the steps to fill out your enrollment form accurately.

1. Use the ‘Get Form’ button to obtain the UME Health Plan Enrollment Form and access it in your chosen online platform.
2. Begin with Section 1, which includes Employee Information. Fill in your full name, marital status, and residence address. Make sure to include your telephone number, the best time to contact you, and your employment details including the date you began full-time work.
3. Continue completing Section 1 by providing your date of birth, employer's details, and physical attributes such as height and weight. Ensure to also enter your Case Number, Employee Number, and Social Security Number accurately.
4. In the same section, indicate your average number of hours worked weekly and the employer’s phone number. Also, enter the location of your employer and claim your status concerning ownership and corporate office roles as applicable.
5. Select the coverage option you are enrolling for—Self Only, Self and Spouse, Self and Children, or Self, Spouse and Children. If waiving coverage for any dependents, provide the reasons and confirm understanding of the implications.
6. Proceed to Section 2, which pertains to Other Coverage. Answer whether you or your dependents have coverage under any health benefit plan and specify the coverage type and details requested.
7. In Section 3, address Medical Information. Answer all medical history questions honestly. If you answer 'Yes' to any conditions, provide additional details in the designated spaces.
8. Complete Section 4 by reading the Employee Statement carefully. Authorize the necessary disclosures and ensure your responses are accurate before signing and dating the form.
9. After filling all required sections, review your form for accuracy and completeness. You can now save your changes, download, print, or share the completed form as necessary.

Begin your enrollment process by completing your UME Health Plan Enrollment Form online today.