Get Idaho Universal Large Group Application

Filling out the Idaho Universal Large Group Application online is a crucial step for enrolling in health coverage outside of the Idaho Exchange. This detailed guide provides a structured approach to completing each section of the application, ensuring that you accurately provide all necessary information.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the Idaho Universal Large Group Application and open it for editing.
2. In Section 1, provide your employer’s name, phone number, address, city, state, and zip code, along with your occupation and weekly working hours. Ensure all information is correct to avoid issues with your application.
3. Complete the applicant information section, including your full legal name, mailing address, county, phone number, email address, date of birth, social security number, and marital status. Be sure to fill in all required fields accurately.
4. If you wish to waive coverage for yourself or any dependents, complete Section 3. Indicate the names of those declining coverage and the reason for doing so by checking appropriate boxes or providing details in the space given.
5. In Section 4, select your enrollment type, whether you are a new applicant, adding dependents, or enrolling during open enrollment. If enrolling outside of open enrollment, specify the reason and provide the corresponding date.
6. List all eligible dependents in Section 5. Provide their names, relationships, social security numbers, dates of birth, and whether they reside at the same address as you.
7. If you have other coverage, complete Section 6 with information about the policy, including the insurance carrier name, policy number, and types of coverage. Indicate if this coverage is terminating and provide the end date.
8. Respond to Section 7 queries regarding any disabilities among dependents and provide relevant details if applicable. Confirm any tobacco use for those 18 or older listed in your application.
9. Review the affirmation in Section 8, confirming that the provided information is accurate. Understand the implications of any misstatements.
10. Sign Section 9, acknowledging your understanding of the application and related coverage terms. Include the date of your signature.
11. Finally, follow the instructions for saving changes to your form, downloading, printing, or sharing it as necessary to complete your application process.

Complete your Idaho Universal Large Group Application online today to secure your health coverage.