Get Keysolution Enrollment Form - The Arnold Group

Filling out the KeySolution Enrollment Form is an important step to ensure that you and your dependents receive the necessary health benefits. This guide will provide a clear, step-by-step approach to assist you in completing this form online with confidence.

Follow the steps to successfully complete your enrollment form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling in the enrollee information section. Provide the group name as 'Arnold and Associates of Wichita, Inc. dba: The Arnold Group', along with your plan coverage effective date, last name, first name, date of birth, sex, social security number, number of hours worked per week, home phone number, street address, work phone number, city, state, and zip code.
3. Select your plan choice from the provided options: MEC Plan, MEC Plus Plan, or MEC Heavy Plan. If applicable, fill in the beneficiary information for life insurance, including their full name, address, city, state, zip, phone number, date of birth, and relationship to you.
4. In the dependent information section, indicate if you wish to be covered along with any dependents. For each dependent, fill in their last name, first name, social security number, date of birth, sex, and specify if they are a spouse, child, or disabled. Repeat this for additional dependents as necessary.
5. If there are disabled dependents, ensure that you submit appropriate documentation to verify their status along with the enrollment form. Also, if a court decree mandates coverage for a dependent, attach the relevant section of the court decree.
6. Review the declaration statement at the bottom of the form carefully. By signing, you agree to the terms detailed in the Summary Plan Description and confirm that the information provided is accurate. Input your printed name, signature, and the date.
7. Finally, save the changes to your form. You may download, print, or share the completed document as needed, ensuring all necessary attachments are included.

Complete your KeySolution Enrollment Form online today to ensure timely access to your benefits.