Get Please Submit Completed Form To Healthsmart Within 30 Days

Filling out the Please Submit Completed Form To HealthSmart Within 30 Days online is a straightforward process designed to help you communicate eligibility changes effectively. This guide will provide you with step-by-step instructions to ensure that you complete the form accurately and submit it in a timely manner.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the form and open it in the online editor or document interface.
2. Begin by entering today’s date in the designated field to establish when the form is being submitted.
3. Provide your employer's information including the company name, group number, contact person, and their phone number.
4. Identify the date of the qualifying event, using the format provided.
5. Select the appropriate reasons for either an addition or termination of coverage by checking the corresponding boxes.
6. If there are dependents being added or terminated, fill in their respective details, including first name, last name, date of birth, and gender.
7. Ensure you complete any necessary additional information regarding dependents or changes in coverage.
8. Review all entries for accuracy, then proceed to save changes, download a copy, or print the completed form for submission.

Take action now to submit your completed form online and ensure your changes are processed within 30 days.