Get Po Box 1557 Enrollment Form Providence Ri 02901-1557

Filling out the PO Box 1557 enrollment form online can seem daunting, but with clear guidance, you can complete it accurately. This step-by-step guide will help you navigate the form's sections, ensuring you provide all necessary information effectively.

Follow the steps to complete the enrollment form successfully.

1. Click ‘Get Form’ button to obtain the enrollment form and open it in your preferred digital document editor.
2. Begin by entering the employer group name and Altus Dental group number at the top of the form. These fields identify your employer and help link your enrollment to the appropriate group.
3. Provide your social security number or subscriber ID number in the designated field. This information ensures that your enrollment is correctly processed and linked to your personal benefits.
4. Next, fill in your subscriber name, including your first and last name. Accurately entering your name is essential for correct identification.
5. Enter your date of birth in the MM/DD/YYYY format. This date is important for verification purposes.
6. Fill out your street address or P.O. Box number along with your apartment number (if applicable), city, state, and zip code. This information is necessary for correspondence regarding your enrollment.
7. Indicate the effective date of action and your date of hire. These dates help determine the start of your coverage and employment status.
8. In the dependent information section, select your qualifying event. This could be open enrollment, a new hire, marriage, or any life event affecting your coverage.
9. Provide the required details of any dependents, such as their names, birth dates, and relationship to you. Make sure to check the box if they are a full-time student over 19, if applicable.
10. Under additions and terminations, specify if you are a new subscriber, adding a dependent, or making other changes. Clearly identify any changes that need to be made.
11. In the dentist information section, list the names and locations of dentists for you or your covered family members. If you are making a status change, indicate that accordingly.
12. Complete any corrections or additional remarks you may have at the end of the form. This section is helpful for providing context for your requests.
13. If applicable, answer questions regarding COBRA and provide information about other insurance coverage you or your dependents may have.
14. Finally, review all entered information for accuracy. Once verified, you can save your changes, download the document, print it, or share it as required before submission.

Complete your PO Box 1557 enrollment form online today for a smooth enrollment experience.