Get Additiontermination Change Form Please Print Neatly Using

The AdditionTermination Change Form is essential for managing changes related to employment and insurance. This guide will provide step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete the AdditionTermination Change Form online.

1. Click the ‘Get Form’ button to access the AdditionTermination Change Form and open it in your preferred editing tool.
2. Begin by entering the Employer/Employee Information. Include the Group ID Number and Employee Insurance ID Number where indicated.
3. Provide the Employer Signature and Date. This section must be completed by the employer before moving forward.
4. In the Transaction section, select either ‘Termination’ or ‘Change’. If changing an address, note that this can be done online or by contacting Oxford.
5. Fill out the required information, specifying the Employee, Spouse/Partner, or Dependent(s) involved in the change. Provide a clear reason for the change, such as ‘Left Employer’ or ‘Switched Plans’.
6. If applicable, complete additional sections related to the effective date, social security number, and other pertinent personal details for each individual involved.
7. Continue filling out any additional information required, such as Retiree Drug Subsidy details, Primary Care Physician ID information, and pre-existing coverage.
8. Complete the Coordination of Benefits section, indicating whether you or your dependents are actively employed or not, along with any prior carrier information.
9. Lastly, ensure that all necessary signatures, including the Employee Signature and Date, are completed before finalizing the document.
10. Once everything is filled out, save your changes and download the form, or print and share it as needed.

Start filling out your AdditionTermination Change Form online today for a smooth and efficient process.