Get Il Gr 67834-49 2011-2026

The IL GR 67834-49 is an essential form for applying for health insurance through small employers in Illinois. This guide aims to provide clear and comprehensive instructions for successfully completing the form online.

Follow the steps to easily complete the IL GR 67834-49 form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the employer details in the designated fields. Include the employer's name, phone number, and address, as this information must be provided by the employer.
3. Indicate the reason for enrollment by marking all applicable options. This may include new enrollment, special enrollment events, or employment status changes.
4. Provide your personal information in the Employee Information section. This includes your first and last name, marital status, date of hire, and contact details.
5. In the Coverage Requested section, specify if you are requesting coverage for yourself, your spouse/domestic partner, and any children. Ensure you select the appropriate plan choices.
6. If declining coverage for yourself or any family members, complete Section C: Waiver of Coverage. Carefully check the applicable boxes to indicate who is waiving coverage.
7. List all eligible family members who should be covered under the policy. Provide their relevant personal details, including names, dates of birth, and relationships.
8. Complete the Current/Prior Coverage Information section, detailing any existing health coverage each applicant had within the 24 months prior to this application.
9. Fill out the Health Statement section by answering all medical questions accurately. Remember that this information is confidential and vital for insurance evaluation.
10. If required, provide additional information regarding any health conditions in Section G, ensuring that all health statements are fully documented.
11. Review the Additional Coverage Options if offered by your employer and complete as necessary.
12. Finally, sign and date the Acknowledgement & Signature section to confirm that all provided information is accurate and complete.
13. Once completed, save changes, download, print, or share the application as needed.

Complete your health insurance application online today for a smoother process.