Get 2016-17 Tlc Enrollment Bformb-01-2016-bfinalbdocx - Shenandoah K12 Va

This guide will help you navigate the process of completing the 2016-17 TLC Enrollment Form-01-2016-FINAL for health benefits offered by the Virginia Department of Human Resource Management. By following these steps, you will ensure a smooth enrollment experience.

Follow the steps to accurately complete the form online:

1. Press the ‘Get Form’ button to access the form and open it in your document editor. Review all instructions carefully before proceeding.
2. Begin by filling out Part 1, which includes the certification and authorization section. Provide your Health Plan ID or Social Security Number along with your name and date of submission. Ensure that you clearly print your information.
3. In Part 2, indicate the reason for submitting the election request by checking the appropriate boxes. Fill in relevant dates such as hire date or the date of a qualifying mid-year event as needed.
4. Proceed to Part 3 to provide identifying information. Fill in your full name, date of birth, contact details, and employment status. Ensure that all information is accurate and complete.
5. Move to Part 4 to select your health care coverage. You can choose to waive enrollment or indicate your preferred plan. Provide detailed information regarding individuals you wish to cover under your plan.
6. In Part 5, the Benefits Administrator will need to certify the form. Ensure all required fields are filled and sign where indicated. Submit the form along with any necessary supporting documentation.
7. Once you have completed the form, you can save your changes, download the document to keep a copy, or print it for submission. Be sure to contact your Benefits Administrator if you have any questions.

Complete your enrollment form online today to secure your health benefits!