Get 314-55 Elig Enroll Card

The 314-55 Elig Enroll Card is essential for enrolling in or updating dental coverage. This guide provides clear, step-by-step instructions to help users complete the form online efficiently.

Follow the steps to fill out the 314-55 Elig Enroll Card online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Complete the subscriber information section accurately. This includes your full name, social security number, and selection of coverage type (dental or vision) as well as your birth date.
3. Indicate your status by checking the appropriate box (active, retiree, COBRA, surviving) and provide your street address, city, state, and ZIP code.
4. In the plan enrollment/update information section, specify the type of update you are submitting, including new enrollment, group transfer, reinstatement, change/correction to information, or termination of benefits.
5. If making changes, provide the previous information and the corrected details in the 'from' and 'to' fields under the rate code change section, if applicable.
6. Fill in any enrollment or correction details for dependents, providing full names, social security numbers, birth dates, and selecting their status (legal, surviving, IRS dependent, disabled, sponsored).
7. Sign and date the form at the bottom, ensuring all information is accurate and complete before submission.
8. Once you have verified that all information is accurate, save your changes, download the document, print it, or share it as needed.

Complete your 314-55 Elig Enroll Card online today for efficient processing of your enrollment or update.