Get Consova 4 -- Benefit Verification And Info Release (surcharge).final.docx

This guide provides clear instructions for accurately completing the ConSova 4 - Benefit Verification and Info Release (Surcharge) form online. Follow these steps to ensure that you provide all necessary information while avoiding delays in processing your request.

Follow the steps to successfully fill out the form.

1. Click the ‘Get Form’ button to access the ConSova 4 - Benefit Verification And Info Release (Surcharge) form and open it in your preferred editor.
2. Begin filling out Section 1: Benefit Verification Information. Start with your name as the associate, followed by your spouse or domestic partner's name, and your contact phone number.
3. Answer the questions regarding your spouse or domestic partner's employment status. If they are employed, confirm whether they are employed by Ahold USA or self-employed. Based on your answers, follow the instructions provided in this section about returning the form.
4. After completing Section 1, sign and date the form. If applicable, have your spouse or domestic partner sign and date Section 2, and ensure their employer completes Section 3.
5. In Section 2, your spouse or domestic partner should authorize the release of their health eligibility information. They need to sign this section to confirm understanding of the consequences of not signing.
6. Complete Section 3 with information from your spouse or domestic partner’s employer. Ensure the HR contact completes every field, including eligibility for Major Medical coverage.
7. After all sections are complete and signed, review the form for accuracy before submitting. You can save the changes, download the completed document, or print it.
8. Submit the filled-out form to ConSova Corporation either by mail, upload it through the provided platform, or fax it as directed.

Begin the process of completing your documents online for a smooth benefit verification experience.