Get Com Part B: Information About Health Coverage Offered By Your Employer 3

Filling out the Com PART B form for health coverage information provided by your employer is an essential task for accessing benefits. This guide offers clear, step-by-step instructions to help you navigate the form easily and accurately.

Follow the steps to complete the form seamlessly.

1. Press the 'Get Form' button to obtain the document and open it in the editor.
2. Provide your employer's name and Employer Identification Number (EIN). This information is crucial for identification and verification.
3. Fill in the employer's address, including the street, city, state, and ZIP code to ensure correct mailing and communication.
4. Indicate the contact person for employee health coverage, along with their phone number if it differs from the main employer's contact number.
5. Record the email address of the person responsible for employee health coverage inquiries.
6. Indicate whether the employee is currently eligible for coverage or will be eligible within the next three months. This information will determine the next steps.
7. If the employee is not currently eligible, specify the date when they will become eligible for coverage.
8. Answer whether the employer offers a health plan that meets the minimum value standard.
9. Provide details about the lowest-cost plan that meets the minimum value standard, including the premium amount and the payment frequency.
10. If there are changes for the upcoming plan year, detail what the employer will change regarding health coverage, including any changes to premiums.
11. Complete the date of change and prepare to review your entries for any errors.
12. Once all sections are properly filled out, save your changes, and download or print the completed form for your records.

Begin filling out your Com PART B form online today to ensure you secure your health coverage.