Get Benefit Verification And Information Release Authorization Form

Filling out the Benefit Verification And Information Release Authorization Form online is a straightforward process that ensures efficient verification of benefits for employees and their dependents. This guide provides step-by-step instructions to help users accurately complete the form with confidence.

Follow the steps to complete your form online

1. Press the ‘Get Form’ button to access the document and open it in your preferred editor.
2. In Section 1, enter your name as the employee, followed by the name of your spouse or domestic partner. Indicate whether your spouse or partner is employed by selecting 'Yes' or 'No'. If you select 'No', you can sign and date Section 1 and submit the form.
3. If your spouse or partner is employed, answer the next question regarding their employment at Hertz. If they work for Hertz, sign and date Section 1. If not, have your spouse or partner sign and date Section 2 before you complete Section 3.
4. For Section 2, your spouse or partner must authorize the disclosure of their healthcare eligibility information. They should specify if they have enrolled in their employer’s medical coverage and, if 'Yes', sign and date this section and provide proof of their coverage. If 'No', they should sign and date Section 2 and ask their employer to complete Section 3.
5. In Section 3, the spouse’s employer must verify eligibility for medical coverage. The employer will complete the required fields and provide their contact information. Ensure that they sign and date this section.
6. After all sections are completed, save your changes. You may download, print, or share the form as needed. Ensure that it is submitted in accordance with the instructions provided.

Complete your documents online today for efficient management of your benefits.